Reporting complications after open radical retropubic prostatectomy using the Martin criteria

Abstract

Purpose: In 2002, 10 Martin criteria were proposed that should be met when reporting complications following surgery. To date, few studies have evaluated complication rates after radical prostatectomy using these criteria. Therefore, we assessed complications in a contemporary series of open retropubic radical prostatectomy using a standardized reporting methodology.

Materials and methods: Complications in 2,893 consecutive patients who underwent radical prostatectomy at a single center between 2003 and 2009 were recorded prospectively. All 10 Martin criteria for a high quality report of complications were fulfilled. Complications within a 30-day postoperative period were graded retrospectively according to the Clavien-Dindo classification.

Results: The overall complication rate was 27.7% (801 of 2,893), and 943 medical and surgical complications were recorded in 801 patients. Of these complications 596 were grade I (63.2%), 183 grade II (19.5%), 142 grade III (15.1%) and 15 grade IV (1.8%). The mortality rate (grade V) was 0.1% (4 of 2,893). Independent predictors of high grade complications (grade III or greater) on multivariate analysis were patient age (HR 1.051, p = 0.002), prostate volume (HR 1.013, p = 0.004) and lymphadenectomy (HR 2.023, p = 0.005).

Conclusions: Complications after radical prostatectomy should be reported using a standardized methodology. Using the Clavien-Dindo classification we observed an acceptable overall complication rate. In the majority of cases lower grade complications occurred. Patients of older age, those with greater prostate volume and those who had undergone simultaneous lymphadenectomy were at risk for higher grade complications.