Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

Andrea Mari, Riccardo Campi, Riccardo Schiavina, Daniele Amparore, Alessandro Antonelli, Walter Artibani, Maurizio Barale, Roberto Bertini, Marco Borghesi, Pierluigi Bove, Eugenio Brunocilla, Umberto Capitanio, Luigi Da Pozzo, Julian Daja, Paolo Gontero, Alessandro Larcher, Vincenzo Li Marzi, Nicola Longo, Vincenzo Mirone, Emanuele MontanariFrancesca Pisano, Francesco Porpiglia, Claudio Simeone, Salvatore Siracusano, Riccardo Tellini, Carlo Trombetta, Alessandro Volpe, Vincenzo Ficarra, Marco Carini, Andrea Minervini

Research output: Contribution to journalArticle

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Abstract

Objective: To identify meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy (PN). Patients and Methods: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumours, between 2013 and 2016, at 26 Italian urological centres (RECORd 2 project). A multivariable logistic regression for surgical complications was performed. A nomogram was created from the multivariable model. Internal validation processes were performed using bootstrapping with 1000 repetitions. Results: Overall, 2584 patients who underwent PN were evaluated for the final analyses. The median (interquartile [IQR]) American Society of Anesthesiologists (ASA) score was 2 (2–3). In all, 72.4% of patients had clinical T1a (cT1a) stage tumours. The median (IQR) Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 7 (6–8). Overall, 34.3%, 27.7%, 38% of patients underwent open PN (OPN), laparoscopic PN (LPN), and robot-assisted PN (RAPN). Overall and major postoperative surgical complications were recorded in 10.2% and 2.5% of patients, respectively. At multivariable analysis, age, ASA score, cT2 vs cT1a stage, PADUA score, preoperative anaemia, OPN and LPN vs RAPN, were significant predictive factors of postoperative surgical complications. We used these variables to construct a nomogram for predicting the risk of postoperative surgical complications. At decision curve analysis, the nomogram led to superior outcomes for any decision associated with a threshold probability of >5%. Conclusion: Several clinical predictors have been associated with postoperative surgical complications after PN. We used this information to develop and internally validate a nomogram to predict such risk.

Original languageEnglish
Pages (from-to)93-102
JournalBJU International
Volume124
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Nomograms
Nephrectomy
Multicenter Studies
Observational Studies
Decision Support Techniques
Anemia
Neoplasms
Logistic Models
Kidney

Keywords

  • complications
  • nephron-sparing surgery
  • nomogram
  • partial nephrectomy
  • renal cell carcinoma
  • robot-assisted partial nephrectomy

ASJC Scopus subject areas

  • Urology

Cite this

Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy : a prospective multicentre observational study (the RECORd 2 project). / Mari, Andrea; Campi, Riccardo; Schiavina, Riccardo; Amparore, Daniele; Antonelli, Alessandro; Artibani, Walter; Barale, Maurizio; Bertini, Roberto; Borghesi, Marco; Bove, Pierluigi; Brunocilla, Eugenio; Capitanio, Umberto; Da Pozzo, Luigi; Daja, Julian; Gontero, Paolo; Larcher, Alessandro; Li Marzi, Vincenzo; Longo, Nicola; Mirone, Vincenzo; Montanari, Emanuele; Pisano, Francesca; Porpiglia, Francesco; Simeone, Claudio; Siracusano, Salvatore; Tellini, Riccardo; Trombetta, Carlo; Volpe, Alessandro; Ficarra, Vincenzo; Carini, Marco; Minervini, Andrea.

In: BJU International, Vol. 124, No. 1, 01.01.2019, p. 93-102.

Research output: Contribution to journalArticle

Mari, A, Campi, R, Schiavina, R, Amparore, D, Antonelli, A, Artibani, W, Barale, M, Bertini, R, Borghesi, M, Bove, P, Brunocilla, E, Capitanio, U, Da Pozzo, L, Daja, J, Gontero, P, Larcher, A, Li Marzi, V, Longo, N, Mirone, V, Montanari, E, Pisano, F, Porpiglia, F, Simeone, C, Siracusano, S, Tellini, R, Trombetta, C, Volpe, A, Ficarra, V, Carini, M & Minervini, A 2019, 'Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)', BJU International, vol. 124, no. 1, pp. 93-102. https://doi.org/10.1111/bju.14680
Mari, Andrea ; Campi, Riccardo ; Schiavina, Riccardo ; Amparore, Daniele ; Antonelli, Alessandro ; Artibani, Walter ; Barale, Maurizio ; Bertini, Roberto ; Borghesi, Marco ; Bove, Pierluigi ; Brunocilla, Eugenio ; Capitanio, Umberto ; Da Pozzo, Luigi ; Daja, Julian ; Gontero, Paolo ; Larcher, Alessandro ; Li Marzi, Vincenzo ; Longo, Nicola ; Mirone, Vincenzo ; Montanari, Emanuele ; Pisano, Francesca ; Porpiglia, Francesco ; Simeone, Claudio ; Siracusano, Salvatore ; Tellini, Riccardo ; Trombetta, Carlo ; Volpe, Alessandro ; Ficarra, Vincenzo ; Carini, Marco ; Minervini, Andrea. / Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy : a prospective multicentre observational study (the RECORd 2 project). In: BJU International. 2019 ; Vol. 124, No. 1. pp. 93-102.
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T1 - Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy

T2 - a prospective multicentre observational study (the RECORd 2 project)

AU - Mari, Andrea

AU - Campi, Riccardo

AU - Schiavina, Riccardo

AU - Amparore, Daniele

AU - Antonelli, Alessandro

AU - Artibani, Walter

AU - Barale, Maurizio

AU - Bertini, Roberto

AU - Borghesi, Marco

AU - Bove, Pierluigi

AU - Brunocilla, Eugenio

AU - Capitanio, Umberto

AU - Da Pozzo, Luigi

AU - Daja, Julian

AU - Gontero, Paolo

AU - Larcher, Alessandro

AU - Li Marzi, Vincenzo

AU - Longo, Nicola

AU - Mirone, Vincenzo

AU - Montanari, Emanuele

AU - Pisano, Francesca

AU - Porpiglia, Francesco

AU - Simeone, Claudio

AU - Siracusano, Salvatore

AU - Tellini, Riccardo

AU - Trombetta, Carlo

AU - Volpe, Alessandro

AU - Ficarra, Vincenzo

AU - Carini, Marco

AU - Minervini, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To identify meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy (PN). Patients and Methods: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumours, between 2013 and 2016, at 26 Italian urological centres (RECORd 2 project). A multivariable logistic regression for surgical complications was performed. A nomogram was created from the multivariable model. Internal validation processes were performed using bootstrapping with 1000 repetitions. Results: Overall, 2584 patients who underwent PN were evaluated for the final analyses. The median (interquartile [IQR]) American Society of Anesthesiologists (ASA) score was 2 (2–3). In all, 72.4% of patients had clinical T1a (cT1a) stage tumours. The median (IQR) Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 7 (6–8). Overall, 34.3%, 27.7%, 38% of patients underwent open PN (OPN), laparoscopic PN (LPN), and robot-assisted PN (RAPN). Overall and major postoperative surgical complications were recorded in 10.2% and 2.5% of patients, respectively. At multivariable analysis, age, ASA score, cT2 vs cT1a stage, PADUA score, preoperative anaemia, OPN and LPN vs RAPN, were significant predictive factors of postoperative surgical complications. We used these variables to construct a nomogram for predicting the risk of postoperative surgical complications. At decision curve analysis, the nomogram led to superior outcomes for any decision associated with a threshold probability of >5%. Conclusion: Several clinical predictors have been associated with postoperative surgical complications after PN. We used this information to develop and internally validate a nomogram to predict such risk.

AB - Objective: To identify meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy (PN). Patients and Methods: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumours, between 2013 and 2016, at 26 Italian urological centres (RECORd 2 project). A multivariable logistic regression for surgical complications was performed. A nomogram was created from the multivariable model. Internal validation processes were performed using bootstrapping with 1000 repetitions. Results: Overall, 2584 patients who underwent PN were evaluated for the final analyses. The median (interquartile [IQR]) American Society of Anesthesiologists (ASA) score was 2 (2–3). In all, 72.4% of patients had clinical T1a (cT1a) stage tumours. The median (IQR) Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 7 (6–8). Overall, 34.3%, 27.7%, 38% of patients underwent open PN (OPN), laparoscopic PN (LPN), and robot-assisted PN (RAPN). Overall and major postoperative surgical complications were recorded in 10.2% and 2.5% of patients, respectively. At multivariable analysis, age, ASA score, cT2 vs cT1a stage, PADUA score, preoperative anaemia, OPN and LPN vs RAPN, were significant predictive factors of postoperative surgical complications. We used these variables to construct a nomogram for predicting the risk of postoperative surgical complications. At decision curve analysis, the nomogram led to superior outcomes for any decision associated with a threshold probability of >5%. Conclusion: Several clinical predictors have been associated with postoperative surgical complications after PN. We used this information to develop and internally validate a nomogram to predict such risk.

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KW - nephron-sparing surgery

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KW - partial nephrectomy

KW - renal cell carcinoma

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