The Effect of Charlson’s Comorbidity Index on Clavien-Dindo Classification of Surgical Complications in Percutaneous Nephrolitotomy

Abstract

Objective Percutaneous nephrolithotomy (PCNL) in comorbid patients is challenging due to the high susceptibility to complications. In our study, by taking the age of patents into account, we have tried to figure out the impact of comorbid conditions on complications identified after PCNL operations in our clinic. Materials and Methods Three hundred-sixty patients, who underwent PCNL in our clinic between June 2002 and June 2012, were retrospectively analyzed. The patients were assessed in terms of demographic characteristics, access locations, preoperative comorbidity using the age-adjusted Charlson’s Comorbidity Index (ACCI) and postoperative complications using the Clavien-Dindo classification of surgical complications. Results The mean age of the patients was 46 (10-83) years. Two hundred-twenty (61.1%) patients were male and 140 (38.9%) were female. According to preoperative ACCI, 169 (46.9%) of the cases were classified as group 1 and 191 (53.1%) of the cases as group 2. In 212 (58.8%) patients, entry into the lower calyx, in 136 (37.7%) - into the middle calyx and in 12 (3.3%) patients, entry into the upper calyx was done. The rate of complications in ACCI group 1, grade 1, grade 2 and grade 3a was 12.4%, 18.9%, 8.28% and in group 2, it was 6.8%, 26.7%, 6.28%, respectively. There was no significant difference between the groups (p=0.098, p=0.16 and p=0.49, respectively). Grade 3b and grade 4a complications were seen only in group 2 (1.04%, 0.52%, resceptively). Grade 4b and 5 complications were not observed in both groups. Conclusion Considering the age of patients, we have not observed a significant difference in the rate of postoperative complications between the groups. Therefore, we assume that the recognized preoperative comorbidities are not risk factors for PCNL procedures and operations.

Keywords

• Percutaneous nephrolithotomy
• the age-adjusted Charlson’s Comorbidity Index
• the Clavien-Dindo Classification of surgical complications