title: Cerebrovascular Disease and Chronic Obstructive Pulmonary Disease Increase Risk of Complications with Robotic Partial Nephrectomy.
abstract: OBJECTIVE
  To identify specific comorbidities within the Charlson Comorbidity Index (CCI) that are associated with increased complication rates after robot-assisted partial nephrectomy (RAPN).
  
  
  METHODS
  After institutional review board approval, a consecutive series of 641 patients undergoing RAPN were retrospectively identified. Perioperative complications were defined and classified using the Clavien grading system. Fisher's exact test or chi-square test was performed to evaluate the association of individual comorbidities with perioperative complications. Logistic regression was used for multivariable analysis to adjust for other non-CCI comorbidities and tumor-specific and patient-specific characteristics.
  
  
  RESULTS
  Of the 641 patients undergoing RAPN, complications occurred in 67 patients (10.5%), including 10 (14.9%), 28 (41.8%), 20 (29.9%), 5 (7.5%), and 4 (6.0%) patients with Clavien grade 1, 2, 3a, 3b, and 4 complications, respectively. Cerebrovascular disease [odds ratio 3.01 (95% confidence interval [CI] 1.10, 8.26) p = 0.03] and chronic obstructive pulmonary disease [COPD; 3.12 (1.24, 7.89) p = 0.02] predicted complications in multivariable analysis of clinicopathologic characteristics, including all CCI and non-CCI comorbidities. In additional modeling with only CCI comorbidities, similar results were observed, with cerebrovascular disease [2.93 (1.04, 7.56) p = 0.04] and COPD [2.69 (1.04, 6.28) p = 0.04] as the only two significant variables. No other variables reached statistical significance in either model, including nephrometry score or estimated blood loss (p >  .50 for both). COPD predicted major complications (Clavien grade 3 or 4) in multivariable analysis [3.19 (1.07, 9.48) p = 0.04].
  
  
  CONCLUSIONS
  Cerebrovascular disease and COPD predict perioperative RAPN complications after RAPN. Identification of patients with these comorbidities preoperatively may afford improved counseling and risk stratification.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Bauman
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Robert Sherburne
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D020521:Stroke / Q000453:epidemiology; D016055:Urinary Retention / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology