title: Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project).
abstract: OBJECTIVE
  To analyze postoperative complications and to assess for significant predictive factors during partial nephrectomy (PN) using a large multicenter dataset.
  
  
  METHODS
  Patients who underwent PN for clinical T1 renal tumors at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project) were evaluated between 2009 and 2012. Anthropometric data, comorbidities and perioperative outcomes were analyzed. Complications were divided as intra- and postoperative, medical and surgical, as appropriate. The severity of postoperative complications was graded according to the modified Clavien classification system. Patients who experienced intraoperative complications were excluded from the analyses for the potential confounding effect in the evaluation of predicting factors for postoperative complications.
  
  
  RESULTS
  Overall, 979 patients were analyzed: open, laparoscopic and robot-assisted (available since 2011) surgical approaches were used in 522 (56.4%), 286 (30.9%) and 117 (12.6%) cases, respectively. Surgical postoperative complications were reported in 121 (13.1%) cases (32 (3.5%) were Clavien 3), medical were reported in 52 (5.6%) cases (3 (0.3%) were Clavien 3). No Clavien 4 complications were reported. At multivariable analysis, ECOG score ≥1 (OR 1.98; p = 0.002), lower preoperative hemoglobin (OR 0.71; p < 0.0001) and open surgical approach (2.91; p = 0.02) were significant predictive factors of overall surgical postoperative complications, ECOG score ≥1 (OR 1.93; p = 0.04) and surgical approach (p = 0.05) were significant predictive factors of Clavien 3 either surgical or medical postoperative complications.
  
  
  CONCLUSIONS
  Comorbidities and surgical approach should be considered in preoperative evaluation of patients undergoing PN, as they resulted to play a significant role in the occurrence of postoperative complications.
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mari
authors.affiliation: Department of Urology, AO Spedali Civili di Brescia, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Department of Urology, Policlinico di Modena, University of Modena, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Department of Urology, University of Bologna, S. Orsola Malpighi Hospital, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Department of Urology, University of Padua, Padua, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ficarra
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Department of Urology, AO Spedali Civili di Brescia, Brescia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Furlan
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Giancane
authors.affiliation: Department of Urology, Policlinico Federico II, University of Naples, Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Longo
authors.affiliation: Department of Urology, Policlinico Federico II, University of Naples, Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Mirone
authors.affiliation: Luna Foundation, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Morgia
authors.affiliation: Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Department of Urology, I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Rovereto
authors.affiliation: Department of Urology, University of Bologna, S. Orsola Malpighi Hospital, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, AO Spedali Civili di Brescia, Brescia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Department of Urology, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. Electronic address: andreamine@libero.it.
authors.forename: A
authors.initials: A
authors.lastname: Minervini
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D001803:Blood Transfusion; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D004621:Embolization, Therapeutic; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011014:Pneumonia / Q000453:epidemiology; D011030:Pneumothorax / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy; D057234:Preoperative Period; D011446:Prospective Studies; D012086:Reoperation; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D014548:Urinary Fistula / Q000453:epidemiology*
chemical_list: D006454:Hemoglobins
keywords: Laparoscopy; Nephron-sparing surgery; Open partial nephrectomy; Partial nephrectomy; Renal cell carcinoma; Robot-assisted partial nephrectomy; Robotics