Summary - Salute per tutti

PRESENTATIONThe Clavien classification system to optimizethe documentation of PCNL morbidity.Jorge Rioja Zuazu 1 , Marcel Hruza 2 , Jens J. Rassweiler 2 ,Jean J.M.C.H. de la Rosette 11 Department of Urology, AMC University Hospital, Amsterdam, The Netherlands;2 Department of Urology, Klinikum Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg,GermanySummaryHigh success rates exceeding 90% are reported with percutaneous nephrolithotomy(PNL) and modifications have further decreased the morbidity while maintaining efficacy.However, complications after or during PNL may occur with an overall complicationrate of up to 83%. Although results from several large series on PNL from outstandingcenters are reported in the literature, there is still no consensus on how todefine complications and stratify them by severity. Hampering comparison of outcome data maygenerate difficulties in informing the patients about the severity of PNL complications.We therefore may conclude that standardization of complications of a certain procedure is necessaryto allow comparison of outcomes between different centers, within a center over time, orbetween different instruments used and/or operating techniques.In 1992, Clavien et al proposed general principles to classify complications of surgery based ona therapy-oriented, 4-level severity grading, allowing identifying most complications and preventingdown rating. The Clavien Classification system differentiates in five degrees of severityupon the intention to treat. Several Urological teams have studied the use of classificationssystems to document and grade outcomes and morbidity of interventions in urology.Also the modified Clavien system has been applied in urological surgery. Urologists have beenusing this classification to grade perioperative complications following laparoscopic radicalprostatectomy, laparoscopic live donor nephrectomy, and retroperitoneoscopy. In the field ofendourology, it has been recently applied to PCNL procedures as well, allowing comparisonamong different series between different hospitals and within the same center.Other benefits that the standardization of the complications by using the Clavien System allowsis to give better information to the patient and, assisting them on making the correct therapeuticalchoice. There may also be a benefit for the health insurance bodies to obtain adequateinformation of the procedure, and the results achieved by a team.Besides all its benefits, the modified Clavien system was proposed as a grading system for perioperativecomplications in general surgery and there are some limitations in classifying PCNLcomplications. A graded classification scheme for reporting the complications of PCNL may beuseful for monitoring and reporting outcomes. There are some limitations in classifying PCNLcomplications. Minor modifications, especially concerning auxiliary treatments, are needed.Further studies are awaited for the development of an accepted classification system applicableto all urologic procedures.KEY WORDS: Percutanous Nephrolithotomy; Complications; Classification.Submitted 9 May 2009; Accepted 30 June 2009A growing demand for health care, rising costs, constrainedresources, and evidence of variations in clinicalpractice have triggered interest in measuring andimproving the quality of health care delivery. For a valuablequality assessment, relevant data on outcome mustbe obtained in a standardized and reproducible mannerto allow comparison among different centers, betweendifferent therapies and within a center over time.Objective and reliable outcome data are increasinglyrequested by patients and payers (government or privateinsurance) to assess quality and costs of health care. Tostandardize the complications of a certain procedure is20Archivio Italiano di Urologia e Andrologia 2010; 82, 1