Early Complications And Their Risk Factors Analysis Of Laparoscopic Cystectomy With Ileal Conduit Diversion Via Modified Clavien System

Purpose:Laparoscopic cystectomy with ileal conduit diversion is a complex surgery commonly with early postoperative complications. The analysis of surgical complications is a vital process when assessing the safety of particular operations. There are differences within the current analysis of the early postoperative surgical complications in the aspect of severity and there is a lack of systematic statistical analysis regarding to this on domestic. This study attempts to explore the early complications and their risk factors of laparoscopic cystectomy with ileal conduit diversion via modified Clavien system.Methods:1. This study determined the interobserver and intraobserve reliabilities of the modified Clavien complication grading system as applied to laparoscopic cystectomy with ileal conduit diversion. Forty complication scenarios were created from database and twenty readers from different centers across China graded the scenarios at two different times. Kappa statistics were performed for interobserver and intraobserver reliabilities.2. Between November2010and November2013in the Department of Urology of Xiangya Hospital of Central South University, early complications of104consecutive cases of laparoscopic cystectomy with ileal conduit diversion were retrospectively analysed via modified Clavien system. Logistic regression analysis was applied to define possible predictors of the complications. Results:1. The Kappa value for intraobserver reliabilities were ranged from0.745to1.000. The overall Kappa value for interobserver reliabilities were ranged from0.809to1.000.2. According to the modified Clavien system,77patients (74.0%) experienced at least1complication within90days of surgery. Of all the104patients68.3%had low grade and22.1%had grade complications.3.On the logistic regression analysis the incidence of the early complications rate correlated significantly with ASA score (P=0.028) and underlying diseases (P=0.001); the incidence of the high Clavien grade early complications rate correlated significantly with peroperative ALB level (P=0.001), interopertive blood transfusion (P=0.001) and postopertive hospital stay (P=0.039)Conclusion:1. The modified Clavien classification system shows high interobserver and intraobserver reliabilities for grading of complications when applied to laparoscopic cystectomy. This grading system may facilitate standardization of complication reporting and make outcome studies more comparable.2. Early postoperative complicatioms following laparoscopic cystectomy is significant even in the most experienced hands, while the rate of high grade complications is acceptably low.3. Accurate reporting of postoperative complications after laparoscopic cystectomy is essential for clinical trial design, combined modality treatment planning, and counseling patients.