University of Oulu

Nisen, H., Erkkilä, K., Ettala, O., Ronkainen, H., Isotalo, T., Nykopp, T., Seikkula, H., Seppänen, M., Tramberg, M., Palmberg, C., Kilponen, A., Pogodin-Hannolainen, D., Mustonen, S., & Veitonmäki, T. (2022). Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification. Scandinavian Journal of Urology, 56(4), 293–300.

Intraoperative complications in kidney tumor surgery : critical grading for the European Association of Urology intraoperative adverse incident classification

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Author: Nisen, Harry1; Erkkilä, Kaisa2; Ettala, Otto3;
Organizations: 1Department of Urology, Abdominal Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
2Department of Surgery,Porvoo Hospital, Porvoo, Finland
3Department of Urology, Turku University Hospital, Turku, Finland
4Department of Urology, Oulu University Hospital, Oulu, Finland
5Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
6Department of Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
7Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
8Department of Surgery, Satakunta Central Hospital, Pori, Finland
9Department of Surgery, Kymenlaakso Central Hospital, Kotka, Finland
10Deparment of Surgery, Vaasa Central Hospital, Vaasa, Finland
11Department of Surgery, Kainuu Central Hospital, Kajaani, Finland
12Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
13Department of Surgery, Lohja Hospital, Lohja, Finland
14Deparment of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Informa, 2022
Publish Date: 2023-06-02


Introduction: The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology.

Aims: We applied and validated EAUiaiC, for kidney tumor surgery.

Patients and methods: A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016–2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of ≥3 units of blood (Grade 2) or as ≥5 units (Grade 3), and also by the exclusion of preemptive conversions.

Results: A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (n = 10) and ureter (n  = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien–Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%).

Conclusions: The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.

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Series: Scandinavian journal of urology
ISSN: 2168-1805
ISSN-E: 2168-1813
ISSN-L: 2168-1805
Volume: 56
Issue: 4
Pages: 293 - 300
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (,which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.