LAUSR

OBJECTIVE This study aimed to comprehensively report complications associated with pelvic exenteration and to determine the strength of associations between three different grading methodologies and length of stay, quality-of-life as well as physical outcomes. BACKGROUND It is generally accepted that pelvic exenteration is associated with high rates of surgical morbidity. However, methods of reporting in the literature are inconsistent, making it difficult to compare surgical outcomes across studies to determine impact of surgery on patients. DESIGN This was a retrospective study. SETTINGS This study was conducted at Royal Prince Alfred Hospital, Sydney. Australia. PATIENTS It included patients who underwent pelvic exenteration between December 2016 and August 2019. MAIN OUTCOME MEASURES Complications were classified according to the Clavien-Dindo Classification, Comprehensive Complication Index and number of postoperative complications. Correlations between length of stay, physical component score, 6-minute walk test and sit-to-stand test; and complications as graded using Clavien-Dindo Classification, CCI and number of complications were explored using Pearson's or Point Biserial Correlation tests. RESULTS A total of 198 patients were included in this study. Clavien-Dindo Classification was moderately positively correlated with length of stay (r = 0.519, p < 0.0001), whereas Comprehensive Complication Index (r = 0.744, p < 0.0001) and the number of complications (r = 0.751, p < 0.0001) showed a strong correlation with length of stay. All these methodologies were moderately inversely correlated with predischarge 6-minute walk test (Clavien-Dindo Classification: r = -0.359, p = 0.008; Comprehensive Complication Index: r = -0.388, p = 0.007; number of complications: r = -0.467, p < 0.0001). LIMITATIONS A single center retrospective study involves a small sample size. Classification of grade I and II complications in this cohort of patients who tend to have complex postoperative recovery was challenging and therefore incomplete. The incomplete data may have affected the correlations. CONCLUSIONS Comprehensive Complication Index and the number of postoperative complications were stronger correlated with length of stay than Clavien-Dindo Classification in pelvic exenteration patients. Comprehensive Complication Index may be a better grading system to classify postoperative complications following pelvic exenteration. See Video Abstract at http://links.lww.com/DCR/B906 .