Open Access

ARTICLE

Improving surgical outcome reporting in lithiasis surgery: a comparative analysis of comprehensive complication index and clavien-dindo classification

Stamatios Katsimperis^1,*, Lazaros Tzelves¹, Georgios Feretzakis², Themistoklis Bellos¹, Panagiotis Deligiannis¹, Andreas Skolarikos¹, Athanasios Papatsoris¹, Iraklis Mitsogiannis¹

1 Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, 15126, Greece
2 School of Science and Technology, Hellenic Open University, Patras, 26335, Greece

* Corresponding Author: Stamatios Katsimperis. Email:

Canadian Journal of Urology 2025, 32(4), 271-282. https://doi.org/10.32604/cju.2025.066395

Received 08 April 2025; Accepted 16 July 2025; Issue published 29 August 2025

Abstract

Background: Accurate complication reporting in endourology remains challenging, with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems. This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy (URL), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) using both systems. Methods: This prospective, single-center, non-interventional study included 473 patients undergoing URL, PCNL, or ESWL from October 2022 to October 2024. Demographic, stone-related, and procedural variables were recorded. Complications were classified using the CDC, and cumulative morbidity was assessed using CCI. Statistical analyses, including univariate and multivariate regression, were performed to identify predictors of higher CCI scores. Results: PCNL was associated with the highest complication rates, including an 11% transfusion rate. ESWL had the lowest complication burden, while URL demonstrated intermediate risk. CCI scores correlated positively with length of stay (LOS; r = 0.47), highlighting its ability to capture overall morbidity. Multivariate analysis identified stone size, operating time, and positive urine culture as significant predictors of higher CCI scores. The CCI provided a more comprehensive representation of morbidity compared to the CDC. Conclusions: CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC, particularly in more invasive procedures such as PCNL. Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.

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Keywords

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