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479 Perioperative risk factors predicting complications rates of augmentation cystoplasty using the modified Clavien classification system in pediatric population
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Perioperative risk factors predicting complications rates of augmentation cystoplasty using the modified Clavien classification system in pediatric population Eur Urol Suppl 2016;15(3);e479
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Telli O.1 , Ozcan C.2 , Hamidi N.2 , Haciyev P. 1 , Karagoz M.A.3 , Hascicek A.M.3 , Soygur T.1 , Burgu B. 1 1 Ankara
University, School of Medicine, Dept. of Pediatric Urology, Ankara, Turkey, 2 Ankara University, School of Medicine, Dept. of
Urology, Ankara, Turkey, 3 Ankara Training and Research Hospital, Dept. of Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: To evaluate preoperative predictive factors for postoperative complications of augmentation cystoplasty in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. MATERIAL & METHODS: A retrospective review of medical records between 1994 and 2014 identified 117 children (64 males and 53 females) who underwent augmentation cystoplasty at two major institutions. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. RESULTS: The mean (SD) age was 9.3 (1.9) years and the mean (SD) follow-up was 5.4 (1.1) years. The mean (SD) hospitalization time was 9.7 (3.6) days. Complications occurred in 29 (24.7%) children; 13 (11.1%) were MCCS grade I, 8 (5.1%) were grade II, 5 (4.2%) were grade III and 3 (2.5%) were grade IV. Anti-reflux surgery, outlet resistance increasing procedures (sling, bladder neck reconstruction), Society of Fetal Urology (SFU) grade 3–4 hydronephrosis, posterior urethral valves, scoliosis and serum creatinine greater than 1.0 mg/dl were statistically significant predictors of complications on univariate analysis. Prior Botox injection history, Mitrofonof Procedure, previous surgery, gender and age were not significant predictors of complications. In the multivariate analysis SFU grade 3–4 hydronephrosis, bladder neck reconstruction and serum creatinine greater than 1.0 mg/dl were statistically significant independent predictors of complications. CONCLUSIONS: Augmentation cystoplasty remains a valid method of treating severe bladder dysfunction in children. SFU grade 3–4 hydronephrosis, outlet resistance increasing procedures and serum creatinine greater than 1.0 mg/dl were the main predictive factors for postoperative complications. Use of a standardized complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.
Perioperative risk factors predicting complications rates of augmentation cystoplasty using the modified Clavien classification system in pediatric population Eur Urol Suppl 2016;15(3);e479
Print! Print!
Telli O.1 , Ozcan C.2 , Hamidi N.2 , Haciyev P. 1 , Karagoz M.A.3 , Hascicek A.M.3 , Soygur T.1 , Burgu B. 1 1 Ankara
University, School of Medicine, Dept. of Pediatric Urology, Ankara, Turkey, 2 Ankara University, School of Medicine, Dept. of
Urology, Ankara, Turkey, 3 Ankara Training and Research Hospital, Dept. of Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: To evaluate preoperative predictive factors for postoperative complications of augmentation cystoplasty in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. MATERIAL & METHODS: A retrospective review of medical records between 1994 and 2014 identified 117 children (64 males and 53 females) who underwent augmentation cystoplasty at two major institutions. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. RESULTS: The mean (SD) age was 9.3 (1.9) years and the mean (SD) follow-up was 5.4 (1.1) years. The mean (SD) hospitalization time was 9.7 (3.6) days. Complications occurred in 29 (24.7%) children; 13 (11.1%) were MCCS grade I, 8 (5.1%) were grade II, 5 (4.2%) were grade III and 3 (2.5%) were grade IV. Anti-reflux surgery, outlet resistance increasing procedures (sling, bladder neck reconstruction), Society of Fetal Urology (SFU) grade 3–4 hydronephrosis, posterior urethral valves, scoliosis and serum creatinine greater than 1.0 mg/dl were statistically significant predictors of complications on univariate analysis. Prior Botox injection history, Mitrofonof Procedure, previous surgery, gender and age were not significant predictors of complications. In the multivariate analysis SFU grade 3–4 hydronephrosis, bladder neck reconstruction and serum creatinine greater than 1.0 mg/dl were statistically significant independent predictors of complications. CONCLUSIONS: Augmentation cystoplasty remains a valid method of treating severe bladder dysfunction in children. SFU grade 3–4 hydronephrosis, outlet resistance increasing procedures and serum creatinine greater than 1.0 mg/dl were the main predictive factors for postoperative complications. Use of a standardized complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.