Abstract

OBJECTIVES: To develop and validate the PREP (Preoperative Risk Evaluation for Partial Nephrectomy) score to predict the probability of major postoperative complications following partial nephrectomy (PN) based on patient comorbidities.PATIENTS AND METHODS: The Premier Healthcare Database was used to identify patients who had undergone elective PN. Through review of ICD-9 codes, we identified patient comorbidities and major surgical complications (Clavien grade 3-5). Multivariable logistic regression was used to identify predictors of major complications. We used half of the set as the training cohort to develop our risk score and the other half as a validation cohort.RESULTS: From 2003-2015, 25,451 PN were performed. The overall rate of major complications was 4.9%. The final risk score consisted of 10 predictors: age, sex, CHF, CAD, COPD, CKD, diabetes, hypertension, obesity, smoking. In the training cohort, the area under the receiver-operator characteristic curve (AUC) was 0.75 (95% CI 0.73-0.78), while the AUC for the validation cohort was 0.73 (95% CI 0.70-0.75). The predicted probabilities of major complication in the low risk (=10 points), intermediate risk (11-20 points), high risk (21-30 points), and very high risk (>30 points) categories were 3% (95% CI 2.6-3.2), 8% (95% CI 7.2-9.2), 24% (95% CI 20.5-27.8), and 41% (95% CI 34.5-47.8) respectively.CONCLUSIONS: We developed and validated the PREP score to predict the risk of complications following PN based on patient characteristics. Calculation of the PREP score can help providers select treatment options for patients with a cT1a renal mass and enhance the informed consent process for patients planning to undergo PN.

View details for DOI 10.1111/bju.15240

View details for PubMedID 32920933