title: Transuretral resection of the bladder (TURB): analysis of complications using a modified Clavien system in an Italian real life cohort.
abstract: BACKGROUND
  To evaluate the applicability of a modified Clavien classification system (CCS) in grading postoperative complications of transurethral resection of bladder tumours (TURB).
  
  
  METHODS
  A series of patients undergoing monopolar TURB from April 2011 to March 2012 at five Italian centers were enrolled. All complications occurring within the first 30-day postoperative period were prospectively recorded and graded according to the CCS.
  
  
  RESULTS
  Overall, 275 patients were included. Median age was 71 (63/78) years; median BMI was 28 (25.4/30.8) Kg/m(2), median tumour size was 2 (1-3) cm; median number of tumour lesions was 1 (1-3). Median operative time was 30 (20/45) min. Fifty-seven complications were recorded in 43 patients. Overall postoperative morbidity rate was 16%. Most of the complications were not serious and classified as Clavien type I (42 cases; 74%) or II (8 cases, 14%). Higher grade complications were scarce: CCS IIIa in 1 case (2%) and CCS IIIb in six cases (10%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. On univariate (73.5 ± 38 versus 36.7 ± 21.6 min) and multivariate analysis longer operative time was an independent predictor of complications (OR: 1.06 per min, 95%CI 1.04-1.08, p = 0.001).
  
  
  CONCLUSIONS
  A modified CCS can be used as a standardized tool to objectively define the complications of TURB which confirms to be a safe procedure with a low surgical morbidity. This tool can be used to aid in patient counselling and to facilitate scientific assessment.
authors.affiliation: University "La Sapienza", Ospedale Sant'Andrea, Dept. of Urology, Roma, Italy. Electronic address: cosimodenunzio@virgilio.it.
authors.forename: C
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: University "La Sapienza", Policlinico Umberto I°, Dept. of Urology, Roma, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Franco
authors.affiliation: Ospedale Padre Pio Da Pietrelcina, Dept. of Urology, Vasto, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cindolo
authors.affiliation: Clinica Urologica, 2nd University of Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Urology Unit, Magna Grecia University of Catanzaro, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Istituto Nazionale Tumori, Fondazione G Pascale, Dept. of Urology, Napoli, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Perdonà
authors.affiliation: AOU Policlinico Vittorio Emanuele, Dept. of Urology, Catania, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Falsaperla
authors.affiliation: Careggi Hospital, University of Florence, Dept. of Urology, Firenze, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gacci
authors.affiliation: University "La Sapienza", Policlinico Umberto I°, Dept. of Urology, Roma, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Leonardo
authors.affiliation: Urology Unit, Magna Grecia University of Catanzaro, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Clinica Urologica, 2nd University of Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: De Sio
authors.affiliation: University "La Sapienza", Ospedale Sant'Andrea, Dept. of Urology, Roma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D012720:Severity of Illness Index; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Bladder cancer; Clavien; Complications; Transurethral resection