title: Chronic pulmonary diseases are independent risk factors for complications after radical nephrectomy.
abstract: OBJECTIVE
  We aimed to identify the prognostic factors and the new parameters such as Charlson's comorbidity index (CCI) that might predict postoperative complication rates in a radical nephrectomy cohort. We also evaluated the correlation of CCI with the Clavien postoperative complication scale (CPCS).
  
  
  METHODS
  Perioperative characteristics of 47 patients undergoing radical nephrectomy were recorded. Following items were assessed: preoperative patient characteristics including age, gender, CCI, American Society of Anesthesiologists (ASA) physical status classification system category, renal and hepatic functions, type of nephrectomy incision, operative time, clinical stage and histopathological subtype of the tumor, and preoperative co-morbid conditions including diabetes mellitus, hypertension, chronic pulmonary disease, peptic ulcers, renal and hepatic dysfunction. Postoperative complications were defined as death, wound infection, pneumonia, atelectasis, pulmonary emboli, anemia, sepsis, cardiac arrhythmia, myocardial infarction, and deep vein thrombosis. In addition, postoperative complications were also graded according to the CPCS and accepted as those occurring within 30 days.
  
  
  RESULTS
  Preoperative chronic pulmonary diseases were found to be significant risk factors for the development of postoperative complications. Age adjusted odds ratio was 7.112 for chronic pulmonary disease. The mean CCI in patients who did not develop any postoperative complication was 4.49 ± 1.95, whereas it was 5.75 ± 2.60 for patients who developed postoperative complications (P = 0.138). In Spearman correlation analysis, CCI value was found to be significantly correlated with CPCS grade (P = 0.011, rho value = 0.366).
  
  
  CONCLUSIONS
  Presence of chronic pulmonary disease is a strong predictor of postoperative complications after radical nephrectomy. Patients with higher preoperative CCI scores may have higher postoperative CPCS grades. Additional studies are warranted.
authors.affiliation: Department of Urology, Karaelmas University School of Medicine, ZKU Tıp Fak Hastanesi S-Blok Kat:4, 67600 Kozlu, Zonguldak, Turkey. h_tokgoz@hotmail.com
authors.forename: Hüsnü
authors.initials: H
authors.lastname: Tokgöz
authors.forename: Bülent
authors.initials: B
authors.lastname: Akduman
authors.forename: İlker
authors.initials: İ
authors.lastname: Ünal
authors.forename: Bülent
authors.initials: B
authors.lastname: Erol
authors.forename: Ersöz
authors.initials: E
authors.lastname: Akyürek
authors.forename: Necmettin Aydin
authors.initials: NA
authors.lastname: Mungan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002908:Chronic Disease; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008171:Lung Diseases / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D018709:Statistics, Nonparametric