Is it worth using the Comprehensive Complication Index over the Clavien-Dindo Classification in elderly patients who underwent percutaneous nephrolithotomy?

Abstract

Purpose To compare the Comprehensive Complication Index (CCI) to the Clavien-Dindo Classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population. Methods We conducted a retrospective study involving patients 60 years and older who underwent standard PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications. Results We included 239 patients with a median age of 65 [63–70] years. 15.5% presented complications and multiple complications occurred in 2.9% of the patients. LOS had a correlation coefficient of 0.291 (p < 0.001) with both CDC and CCI. Admission to the ER had a coefficient of 0.284 (p < 0.001) with CDC and 0.286 (p < 0.001) with CCI. Higher American Anesthesiology Association (ASA) physical status (p = 0.04), higher Guy’s Hospital Kidney Stone Classification (p = 0.02) and lower post-surgery hematocrit level (p = 0.046) exhibited significant univariate correlations with complications. After multivariate analysis, only a higher ASA physical status (p = 0.01) showed independent correlation with complications. Conclusion A higher ASA physical status arose as an independent predictor of complications following PCNL in the elderly population. The use of the CCI following this procedure in this population did not yield benefits over the widely used CDC.