EVALUATION OF TRANSURETHRAL BLADDER RESECTION COMPLICATIONS: A MODIFIED CLAVIEN CLASSIFICATION SYSTEM ANALYSIS

Introduction: The modified Clavien classification system (CCS) has been proposed to classify and grade complications in general surgery. It is increasingly becoming popular in urology although has never been used to date in common procedures such as transurethral resection of bladder tumor (TURB). The aim of our study is to evaluate the applicability of the modified CCS in reporting and grading the severity of perioperative complications in patients with bladder tumor treated with TURB. Patients and Methods: A consecutive series of patients with bladder lesions who underwent transurethral resection of bladder tumour (TURB) from April 2011 to August 2011 at six academic centres were evaluated for complications occurring up to the end of the first postoperative month. Variables analyzed for each patient were: age, sex, diabetes, hypertension, ischemic heart disease, score, tumor size, number of lesions, grade of tumor, anticoagulation therapy, type of diversion, operation time, preoperative hydronefrosis and BMI. All complications were prospectively recorded and classified according to the modified CCS. Results were presented as complication rates per grade. Chisquare, Kruskal Wallis tests and logistic regression analysis were used for statistical analysis. Results: 275 patients were consecutively enrolled. Mean age was 68.26±8.1 years; mean BMI was 28.3±4 Kg/m2, mean tumour size was 2.38±2.3 cm; mean number of tumour lesions was 2.52±2.3. All patients underwent a monopolar TURB. Mean operative time was 43±28 m. Fifty-six complications were recorded in 51 patients. Overall perioperative morbidity rate was 18.5%. Most of them were not serious (haematuria and clot retention) and were classified as Clavien type I (42 cases; 75%) or II (8 cases, 14%). Higher grade complications were scarce: CCS IIIb in six cases (11%). 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 association between Age, sex, ASA score, anti-coagulant treatment, BMI,tumor size, number of lesions, diabetes, hypertension, ischemic heart disease and hospital stay with the number of complications were observed. On univariate (73.5±38 vs. 36.7±21.6 minutes) and multivariate analysis longer operative time was the only independent parameter associated with a higher risk of CCS type I complications (OR: 1.040 per minute, 95%CI 1.025-1.055, p=0.001). Grade Complications I 42 II 8 IIIb 6 IV 0 V 0. Conclusion: 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. 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.