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

PURPOSE: To identify the meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy. MATERIALS AND METHODS: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumors between 2013 and 2016 at 26 urological Italian centers (RECORd 2 project). A multivariable logistic regression for surgical complication was performed. A nomogram was created from the multivariable model. Internal validation processes were performed using bootstrapping with 1000 repetitions. RESULTS: Overall, 2584 patients undergone PN were evaluated for the final analyses. The median American Society of Anaesthesiologists (ASA) score was 2 (IQR 2-3). Patients had a cT1a stage in 72.4% of the cases. Median PADUA score was 7 (IQR 6-8). Overall, 34.3%, 27.7%, 38% of patients underwent open, laparoscopic and robotic PN. Overall and major postoperative surgical complications were recorded in 10.2% and 2.5% of patients. At multivariable analysis, age, ASA score, clinical T2 versus T1a stage, PADUA score, preoperative anaemia, open, and laparoscopic versus robotic approach 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 above 5%. CONCLUSION: Several clinical predictors have been associated with postoperative surgical complications. We used this information to develop and internally validate a nomogram to predict such risk. This article is protected by copyright. All rights reserved.