Factors affecting intraoperative and postoperative complications of RIRS
classified by the Clavien and Satava grading systems
Abstract
Objective: To classify intraoperative and postoperative complications
using the modified Clavien classification system (MCCS) and modified
Satava classification system (SCS) and to evaluate the parameters
associated with complications in patients undergoing retrograde
intrarenal surgery (RIRS) for renal and proximal ureteral stones.
Materials and Methods: We performed a retrospective analysis of 949
patients who underwent RIRS for renal stones and upper ureteral stones
at two institutions between March2015 and June2020. Intraoperative
complications were assessed using SCC and postoperative complications
were graded according to MCCS. Univariate and multivariate analyses were
undertaken to determine predictive factors affecting complication rates.
Results: The female/male ratio of 949 patients was found to be 346
(36.5)/603(63.5). The median stone size was determined as 13 mm. The
stone-free rate was 83.6%after the first intervention, and the final
stone-free rate was 94.4% after re-procedure. According to SCS, the
intraoperative event and complication incidence was 153(16.1%). MCCS
revealed postoperative complications in 121(12.8%) patients. Major
complications were observed in 18(1.9%) patients. The rate of
complications was higher in patients with renal anomalies (9.9% vs
3.9%, p=0.006). Besides, stone localization, size, number and density
were associated with the development of complications
(p<0.001, p<0.001, p<0.001 and p=0.002,
respectively). In addition, the multivariate analysis revealed that for
the patients with grade≥3 complications according to MCCS, only
stone-free status was a significant predictor of complication
development (p=0.044) whereas for those with grade ≥2b complications
according to SCS, significant predictors were stone size
(p<0.001), stone density (p=0.022), and fluoroscopy time
(p<0.001). Conclusion: This study showed that abnormal kidney
anatomy, multiple stones, operative time, and stone-free status were
reliable predictors of complication development during and after RIRS.
Appropriate preoperative management should be planned according to these
predictors to prevent intraoperative and postoperative complications.