title: Critical analysis of 30 day complications following radical nephroureterectomy for upper tract urothelial carcinoma.
abstract: BACKGROUND
  Patients with upper tract urothelial carcinoma (UTUC) are often elderly and comorbid owing to associated risk factors for developing this malignancy. Perioperative complications may be significant in such a surgical population. We define the incidence and risk factors associated with perioperative complications occurring within 30 days of radical nephroureterectomy (RNU).
  
  
  METHODS
  Medical records of 92 consecutive patients undergoing RNU were reviewed. Complications occurring within 30 days of surgery were graded using the modified Clavien-Dindo classification. The number, severity, and type of complications were recorded. Minor complications were classified as Clavien II or less, while major complications were Grade III or greater. Univariate and multivariate analyses determined variables associated with complications.
  
  
  RESULTS
  Fifty-seven men and 35 women with a median age of 70 years were included. Three-quarters of the cohort underwent a minimally invasive RNU and 45% had a regional lymph node dissection. Final pathology noted that 53% had muscle-invasive and 70% had high grade UTUC. Overall, 35 patients (38%) experienced complications within 30 days of RNU including 11 (12%) with major complications. Ten patients (11%) had multiple complications. Hematologic, gastrointestinal, and infectious etiologies comprised over 75% of complications. On univariate analysis, patient age, ECOG performance status, surgical approach, non-organ confined disease, and cardiac history were associated with complications. In a multivariate model including these variables, only ECOG ≥ 2 (OR 3.9, 95% CI 1.6-7.4, p < 0.001) was independently associated with post-RNU complications.
  
  
  CONCLUSIONS
  Almost 40% of patients in this cohort experienced a perioperative complication after RNU. One-third of complications were Clavien III or greater. Poor performance status conferred a four-fold greater risk of a perioperative complication. Such knowledge may guide patient counseling and surgical expectations for the postoperative period.
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Yu-Kuan
authors.initials: YK
authors.lastname: Lin
authors.forename: Amanda
authors.initials: A
authors.lastname: Deliere
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lehman
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Harpster
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Kaag
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*