EVALUATION OF POST-OPERATIVE TURB COMPLICATIONS: A MODIFIED CLAVIEN CLASSIFICATION SYSTEM ITALIAN CO- HORT ANALYSIS

Aim of the study To evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of bladder tumors (TURB). Materials and methods A consecutive series of patients with bladder lesions who underwent transurethral resection of bladder tumor (TURB) from April 2011 to March 2012 at eight academic centres were evaluated for compli- cations occurring up to the end of the first postoperative month. All complications were prospectively recorded and classified according to the modified CCS. Results were presented as complication rates per grade. Chi-square, Kruskal Wallis tests and logistic regression analysis were used for statistical analysis. Results 494 patients were consecutively enrolled. Mean age was 70.89±11 years; mean BMI was 27.2±9.7 Kg/m2, mean tumor size was 2.1±2.2 cm (range 0.4-10 cm); mean number of tumor lesions was 2.52±2.9 (range 1-20). All patients underwent a monopolar TURB. Mean operative time was 33±22 minutes. One-hundred and six complications were recorded in 97 patients. Overall periopera- tive morbidity rate was 21%. Most of them were not serious (hae- maturia and clot retention) and were classified as Clavien type I (87 cases; 82%) or II (12 cases, 11%). Higher grade complications were scarce: CCS III in seven cases (6%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. No significant associa- 163 Aim of the study To evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of bladder tumors (TURB). Materials and methods A consecutive series of patients with bladder lesions who underwent transurethral resection of bladder tumor (TURB) from April 2011 to March 2012 at eight academic centres were evaluated for compli- cations occurring up to the end of the first postoperative month. All complications were prospectively recorded and classified according to the modified CCS. Results were presented as complication rates per grade. Chi-square, Kruskal Wallis tests and logistic regression analysis were used for statistical analysis. Results 494 patients were consecutively enrolled. Mean age was 70.89±11 years; mean BMI was 27.2±9.7 Kg/m2, mean tumor size was 2.1±2.2 cm (range 0.4-10 cm); mean number of tumor lesions was 2.52±2.9 (range 1-20). All patients underwent a monopolar TURB. Mean operative time was 33±22 minutes. One-hundred and six complications were recorded in 97 patients. Overall periopera- tive morbidity rate was 21%. Most of them were not serious (hae- maturia and clot retention) and were classified as Clavien type I (87 cases; 82%) or II (12 cases, 11%). Higher grade complications were scarce: CCS III in seven cases (6%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. No significant associa- Aim of the study To evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of bladder tumors (TURB). Materials and methods A consecutive series of patients with bladder lesions who underwent transurethral resection of bladder tumor (TURB) from April 2011 to March 2012 at eight academic centres were evaluated for complications occurring up to the end of the first postoperative month. All complications were prospectively recorded and classified according to the modified CCS. Results were presented as complication rates per grade. Chi-square, Kruskal Wallis tests and logistic regression analysis were used for statistical analysis. Results 494 patients were consecutively enrolled. Mean age was 70.89±11 years; mean BMI was 27.2±9.7 Kg/m2, mean tumor size was 2.1±2.2 cm (range 0.4-10 cm); mean number of tumor lesions was 2.52±2.9 (range 1-20). All patients underwent a monopolar TURB. Mean operative time was 33±22 minutes. One-hundred and six complications were recorded in 97 patients. Overall perioperative morbidity rate was 21%. Most of them were not serious (haematuria and clot retention) and were classified as Clavien type I (87 cases; 82%) or II (12 cases, 11%). Higher grade complications were scarce: CCS III in seven cases (6%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. No significant associations between age, sex, ASA score, anti-coagulant treatment, BMI, tumor size, number of lesions and hospital stay with the number of complications were observed. On univariate (47±27 vs. 30±19 minutes) and multivariate analysis longer operative time was the only independent parameter associated with a higher risk of CCS type I complications (OR: 1.036 per minute, 95% CI 1.017-1.056, p=0.001). Discussion The modified CCS represents a practical and easily applicable tool that may help urologists to classify the complications of TURB in a more objective and detailed way. Conclusions In our experience, using this CCS tool, TURB is a safe procedure with a low morbidity rate. Post-operative bleeding is the most significant complication that determines a reoperation. A longer operative time is a significant risk factor for not serious post-operative complications