Katsimperis S. et al., 2025: Improving surgical outcome reporting in lithiasis surgery: a comparative analysis of comprehensive complication index and Clavien-Dindo classification.
Stamatios Katsimperis 1, Lazaros Tzelves 1, Georgios Feretzakis 2, Themistoklis Bellos 1, Panagiotis Deligiannis 1, Andreas Skolarikos 1, Athanasios Papatsoris 1, Iraklis Mitsogiannis 1
1Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, 15126, Greece.
2School of Science and Technology, Hellenic Open University, Patras, 26335, Greece.
Abstract
Background: Accurate complication reporting in endourology remains challenging, with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems. This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy (URL), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) using both systems.
Methods: This prospective, single-center, non-interventional study included 473 patients undergoing URL, PCNL, or ESWL from October 2022 to October 2024. Demographic, stone-related, and procedural variables were recorded. Complications were classified using the CDC, and cumulative morbidity was assessed using CCI. Statistical analyses, including univariate and multivariate regression, were performed to identify predictors of higher CCI scores.
Results: PCNL was associated with the highest complication rates, including an 11% transfusion rate. ESWL had the lowest complication burden, while URL demonstrated intermediate risk. CCI scores correlated positively with length of stay (LOS; r = 0.47), highlighting its ability to capture overall morbidity. Multivariate analysis identified stone size, operating time, and positive urine culture as significant predictors of higher CCI scores. The CCI provided a more comprehensive representation of morbidity compared to the CDC.
Conclusions: CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC, particularly in more invasive procedures such as PCNL. Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.
Can J Urol. 2025 Aug 29;32(4):271-282. doi: 10.32604/cju.2025.066395. PMID: 40910324.
FREE ARTICLE
Comments 1
The authors of this report studied the outcome of stone surgical procedures: SWL, URS and PCNL in terms of complications. They used the Clavien-Dindo classification (CDC) in combination with a comprehensive complication index (CCI). Their conclusion was that that CCI with its superior sensitivity resulted in a more nuanced description of complications than CDG alone.
The cumulated CCI was obtained by taking in account all possible complications that occurred during surgery and up to 30 days thereafter. The CCI was calculated with a special on-line tool which the reviewer was unable to download. Nevertheless, details of that process are given in the report.
This analytical approach was applied in 209 patients treated with SWL, 211 with URS and 53 with PCNL. There are several interesting findings reported in the publication. Of importance is that for SWL there were four different complications if hematuria is included. Most frequent was pain. For comparison there were 8 different complications for URS and 7 for PCNL.
Interestingly, patients with high BMI had fewer complications. The interpretation of that finding was the loss of energy during shockwave transfer over the longer skin-to-stone distance. As expected, CCI was lower for SWL compared with URS and PCNL. The high rate of transfusion (11%) in PCNL-treated patients is emphasized
The authors’ conclusion was that CCI is superior to CDC for evaluation of intraoperative and postoperative adverse events.
The details for CCI calculations are found on-line. For that process the input of CDC is required.
Hans-Göran Tiselius