The rate of postoperative complications might vary according to the method used to collect perioperative data. We aimed at assessing the impact of the prospective implementation of the European Association of Urology (EAU) guidelines on reporting and grading of complications in prostate cancer patients undergoing robot-assisted radical prostatectomy (RARP). From September 2016, an integrated method for reporting surgical morbidity based on the EAU guidelines was implemented at a single, tertiary center. Perioperative data were prospectively and systematically collected during a patient interview at 30 d after surgery as recommended by the EAU Guidelines Panel Recommendations on Reporting and Grading Complications. The rate and grading of complications of 167 patients who underwent RARP ± pelvic lymph node dissection (PLND) after the implementation of the prospective collection system (Group 1) were compared with 316 patients treated between January 2015 and August 2016 (Group 2) when a system based on patient chart review was used. No differences were observed in disease characteristics and PLND between the two groups (all p ≥ 0.1). Postoperative complications were graded according to the Clavien-Dindo classification system. Overall, the complication rate was higher when the prospective collection system based on the EAU guidelines was used (29%) than when retrospective chart review (10%; p < 0.001) was used. In particular, a substantially higher rate of grade 1 (8.4% vs 4.7%) and 2 (14% vs 2.8%) complications was detected in Group 1 versus Group 2 (p < 0.001). Although the rate of complications occurred during hospitalization did not differ (13% vs 10%; p = 0.3), 31 (19%) complications after discharge were detected in Group 1. This resulted into a readmission rate of 16%. Conversely, no complications after discharge and readmissions were recorded for Group 2. The implementation of the EAU guidelines on reporting perioperative outcomes roughly doubled the complication rate after RARP and allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed, where patients assessed with the EAU implemented protocol had a threefold higher likelihood of reporting complications.

Patient summary

The implementation of the European Association of Urology guidelines on reporting and grading of complications after urologic procedures in prostate cancer patients roughly doubled the complication rate after robot-assisted radical prostatectomy compared to retrospective patient chart review. Moreover, it allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed.

中文翻译：

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欧洲泌尿外科协会指南小组建议的执行对机器人辅助根治性前列腺切除术后围手术期报告和分级并发症的影响

术后并发症的发生率可能会根据收集围手术期数据的方法而有所不同。我们旨在评估预期实施的欧洲泌尿外科协会（EAU）指南对接受机器人辅助根治性前列腺切除术（RARP）的前列腺癌患者的并发症的报告和分级的影响。从2016年9月开始，在一个单一的三级中心实施了基于EAU指南的报告手术发病率的综合方法。根据EAU指南小组关于报告和分级并发症的建议，在手术后30 d的患者访谈中前瞻性和系统地收集围手术期数据。将前瞻性收集系统实施后167例接受RARP±盆腔淋巴结清扫术（PLND）的患者的并发症发生率和等级（组1）与2015年1月至2016年8月间治疗的316例患者（组2）进行了比较使用基于患者病历检查的系统。两组之间在疾病特征和PLND上均未观察到差异（所有p  ≥0.1）。术后并发症根据Clavien-Dindo分类系统分级。总体而言，使用基于EAU指南的前瞻性收集系统时（29％），其并发症发生率高于使用回顾性图表审查时（10％；p  <0.001）的并发症发生率。特别是，在第1组比第2组中发现1级（8.4％vs. 4.7％）和2级（14％vs 2.8％）并发症的发生率明显更高（p  <0.001）。尽管住院期间并发症发生率没有差异（13％vs 10％；p = 0.3），在第1组中发现出院后并发症31（19％），这导致再入院率为16％。相反，第2组未记录出院和再次入院后的并发症。实施EAU报告围手术期结局的指导原则使RARP术后并发症发生率大约翻了一番，并允许15％以上的患者出院后发现并发症否则会被遗漏，因为接受EAU实施方案评估的患者报告并发症的可能性高三倍。

病人总结

与回顾性患者图表回顾相比，欧洲泌尿外科协会关于前列腺癌患者泌尿外科手术后并发症报告和分级的指南的实施，使机器人辅助根治性前列腺切除术后的并发症发生率大约翻了一番。此外，它可以在出院后检测出超过15％的本来会遗漏的患者中的并发症。