Skip to main content

Chronic pulmonary diseases are independent risk factors for complications after radical nephrectomy



We aimed to identify the prognostic factors and the new parameters such as Charlson’s comorbidity index (CCI) that might predict postoperative complication rates in a radical nephrectomy cohort. We also evaluated the correlation of CCI with the Clavien postoperative complication scale (CPCS).

Materials and methods

Perioperative characteristics of 47 patients undergoing radical nephrectomy were recorded. Following items were assessed: preoperative patient characteristics including age, gender, CCI, American Society of Anesthesiologists (ASA) physical status classification system category, renal and hepatic functions, type of nephrectomy incision, operative time, clinical stage and histopathological subtype of the tumor, and preoperative co-morbid conditions including diabetes mellitus, hypertension, chronic pulmonary disease, peptic ulcers, renal and hepatic dysfunction. Postoperative complications were defined as death, wound infection, pneumonia, atelectasis, pulmonary emboli, anemia, sepsis, cardiac arrhythmia, myocardial infarction, and deep vein thrombosis. In addition, postoperative complications were also graded according to the CPCS and accepted as those occurring within 30 days.


Preoperative chronic pulmonary diseases were found to be significant risk factors for the development of postoperative complications. Age adjusted odds ratio was 7.112 for chronic pulmonary disease. The mean CCI in patients who did not develop any postoperative complication was 4.49 ± 1.95, whereas it was 5.75 ± 2.60 for patients who developed postoperative complications (P = 0.138). In Spearman correlation analysis, CCI value was found to be significantly correlated with CPCS grade (P = 0.011, rho value = 0.366).


Presence of chronic pulmonary disease is a strong predictor of postoperative complications after radical nephrectomy. Patients with higher preoperative CCI scores may have higher postoperative CPCS grades. Additional studies are warranted.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    PubMed  Article  Google Scholar 

  2. Hakimi AA, Rajpathak S, Chery L, Shapiro E, Ghavamian R (2010) Renal insufficiency is an independent risk factor for complications after partial nephrectomy. J Urol 183:43–47

    PubMed  Article  CAS  Google Scholar 

  3. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383

    PubMed  Article  CAS  Google Scholar 

  4. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    PubMed  Article  Google Scholar 

  5. Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75:1236–1242

    PubMed  Article  CAS  Google Scholar 

  6. Nazemi T, Galich A, Sterrett S, Klingler D, Smith L, Balaji KC (2006) Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results. Int Braz J Urol 32:15–22

    PubMed  Article  Google Scholar 

  7. Han KR, Kim HL, Pantuck AJ, Dorey FJ, Figlin RA, Belldegrun AS (2004) Use of American Society of Anesthesiologists physical status classification to assess perioperative risk in patients undergoing radical nephrectomy for renal cell carcinoma. Urology 63:841–847

    PubMed  Article  Google Scholar 

  8. Kroenke K, Lawrence VA, Theroux JF, Tuley MR (1992) Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med 152:967–971

    PubMed  Article  CAS  Google Scholar 

  9. Sakai RL, Abrão GM, Ayres JF, Vianna PT, Carvalho LR, Castiglia YM (2007) Prognostic factors for perioperative pulmonary events among patients undergoing upper abdominal surgery. Sao Paulo Med J 125:315–321

    PubMed  Article  Google Scholar 

  10. Tisi GM (1979) Preoperative evaluation of pulmonary function. Validity, indications, and benefits. Am Rev Respir Dis 119:293–310

    PubMed  CAS  Google Scholar 

  11. Mohr DN, Jett JR (1988) Preoperative evaluation of pulmonary risk factors. J Gen Intern Med 3:277–287

    PubMed  Article  CAS  Google Scholar 

  12. Jackson CV (1988) Preoperative pulmonary evaluation. Arch Intern Med 148:2120–2127

    PubMed  Article  CAS  Google Scholar 

  13. Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S (1993) Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest 104:1445–1451

    PubMed  Article  CAS  Google Scholar 

  14. Ather MH, Nazim SM (2010) Impact of Charlson’s comorbidity index on overall survival following tumor nephrectomy for renal cell carcinoma. Int Urol Nephrol 42:299–303

    PubMed  Article  Google Scholar 

  15. Erol B, Tuncel A, Hanci V, Tokgoz H, Yildiz A, Akduman B, Kargi E, Mungan A (2010) Fournier’s gangrene: overview of prognostic factors and definition of new prognostic parameter. Urology 75:1193–1198

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

No competing financial interests exist.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Hüsnü Tokgöz.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tokgöz, H., Akduman, B., Ünal, İ. et al. Chronic pulmonary diseases are independent risk factors for complications after radical nephrectomy. Int Urol Nephrol 43, 1025–1031 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Complications
  • Early
  • Radical nephrectomy
  • Risk factors