Obesity, hypertension and diabetes mellitus affect complication rate of different nephrectomy techniques | Actas Urológicas Españolas (English Edition)

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Hua, C. Ying-Ying, F. Zu-Jun, X. Gang, X. Zu-Quan, D. Qiang, J. Hao-Wen" "autores" => array:7 [ 0 => array:3 [ "nombre" => "X." "apellidos" => "Hua" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "1" "identificador" => "fn1" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Ying-Ying" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "1" "identificador" => "fn1" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Zu-Jun" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "X." "apellidos" => "Gang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "X." "apellidos" => "Zu-Quan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "D." 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"apellidos" => "Hao-Wen" "email" => array:1 [ 0 => "haowen_jiang@126.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Urología, Huashan Hospital, Fudan University, Shanghai, PR China" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Nefrología, Huashan Hospital, Fudan University, Shanghai, PR China" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La obesidad, la hipertensión y la diabetes mellitus afectan la tasa de complicaciones de las diferentes técnicas de nefrectomía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2866 "Ancho" => 2496 "Tamanyo" => 298693 ] ] "descripcion" => array:1 [ "en" => "Rates of complications in each category. (A) Rates of complications in each category in LRN and open RN. (B) Rates of complications in each category in LPN and open PN." ] ] ] "textoCompleto" => "IntroductionShort-term postoperative outcomes of surgical procedures are generally applied to assess the quality of care offered to the patient. Kidney tumors are one of the most commonly diagnosed types of cancer. In 2012 the estimated number of new cases of renal tumors in the USA was 64,770, thus ranking eighth among all tumors.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In Spain, a rapid upward trend in the incidence, mortality and prevalence of kidney cancer has also been observed in the last ten years.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Over the last few decades, new surgical techniques have been applied for the treatment of renal tumors, such as partial nephrectomy (PN) and laparoscopic surgery. Previous studies have shown that PN can provide equivalent oncologic control as for radical nephrectomy (RN) in renal tumors less than 4cm in diameter, with the benefit of preserving renal function.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a> Laparoscopic RN (LRN) and laparoscopic PN (LPN) have emerged as minimally invasive alternatives to open surgery, with shorter recovery periods, a shorter postoperative hospital stay and a shorter convalescence time.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Given the westernization of lifestyles and eating habits, both the prevalence of metabolic disorders, as well as hypertension, diabetes mellitus (DM) and obesity are increasing in China and have become a major public health problem.<a class="elsevierStyleCrossRefs" href="#bib0035">7–9</a> Previous studies have provided inconsistent results as to whether hypertension, DM and obesity might increase the postoperative complication rate of nephrectomy.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> The Clavien classification system has been proposed in order to determine the complications of surgery.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> This system has recently been modified and prospectively validated in a large group of patients.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> We conducted this study with the aim of assessing whether hypertension, diabetes and obesity increase the risk for complications after RN or PN.Materials and methodsPatient sourceAfter obtaining approval of the Institutional Review Board of Huashan Hospital, Fudan University, Shanghai, China, a retrospective study of medical records from March 2006 to November 2012 was performed to identify all patients who had undergone RN or PN for presumed renal tumor. Patients were excluded from the study in case their BMI, their medical records regarding hypertension or DM, or the pathological–surgical or postoperative information were not available. We identified a total of 843 patients, 613 of whom had undergone RN (88 had LRN, 526 had open RN) and 229 had undergone PN (42 had LPN, 187 had open PN). Written consent was given by the patients for their information to be stored in the hospital database and used for research. Both LRN and LPN were performed via the transperitoneal approach in the modified lateral decubitus position.Patient characteristicsThe clinical information of the patients, such as height, weight, blood pressure, fasting blood glucose level, medical history of hypertension and DM, was collected on admission. DM was defined as pharmacological treatment for type 2 DM, an elevated fasting plasma glucose level (≥7.0mmol/L), or an elevated 2-h postprandial plasma glucose level (≥11.1mmol/L) on admission. Hypertension was defined as pharmacological treatment for hypertension or elevated blood pressure (≥140/90mm Hg) on admission. BMI was calculated (Quetelet index), which was defined according to the patient's weight in kilogram divided by their height in meter.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Patients were divided into 4 groups based on the recommendations from the World Health Organization (WHO)<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and the clinical guidelines for obesity control in China, including underweight patients, less than 18.5kg/m2, normal-weight patients from 18.5kg/m2 to 23.9kg/m2, overweight patients between 24kg/m2 and 27.9kg/m2 and obese patients with 28kg/m2 or more. Pathological tumor size was mainly determined by imaging techniques. In the case of those patients without detailed imaging information, the intra-operative size was used.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Pathological profiles were blindly determined by 2 independent pathologists according to the 2004 WHO classification.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Primary outcomes2 outcomes were assessed in the patients treated with nephrectomy throughout hospitalization or within 30 days following surgery, including: (1) postoperative complications; and (2) mortality. Operative characteristics and complications were prospectively recorded in our renal surgery database. We identified specific ICD-9 codes for acute renal failure, wound complications, postoperative infection, thromboembolic complications, postoperative hemorrhage, neurologic complications and for miscellaneous technical complications related to surgery. Each measure had been previously described by the complications screening program.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>In order to be able to quantify surgical complication severity, we applied the standardized method (modified Clavien classification system)<a class="elsevierStyleCrossRef" href="#bib0065">13</a> in order to divide the complications into 5 major categories: grade I, any deviation from the normal intraoperative or postoperative course, including the need for administering pharmacologic treatment other than antiemetics, antipyretics, analgesics, diuretics, electrolytes, or physiotherapy; grade II, complications requiring only the use of intravenous medications, total intravenous nutrition, or blood transfusion; grade III, those complications needing surgical, endoscopic, or radiologic intervention under general anesthesia; grade IVa, life-threatening complications requiring ICU management: single-organ dysfunction or failure (including hemodialysis); grade IVb, life-threatening complications requiring ICU management: multi-organ dysfunction; grade V, death of the patient (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Grade I and grade II complications were defined as low-grade complications, and grade III, grade IV and grade V complications as serious or high-grade ones.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Statistical analysisPatient age, tumor size, length of postoperative hospital stay, blood loss during surgery and blood transfusions during operation were expressed as mean±standard deviation, and a two-way analysis of variance was used to make a comparison among all the groups in the parametric analysis. Non-parametric data, such as sex (male/female), side of tumor (right/left), cancer category and complications were evaluated using Fisher's exact or Chi-square tests. All statistical testing was two-sided, and performed using SPSS version 19.0 for Windows (SPSS Inc., Chicago, Illinois, USA); p<0.05 was considered statistically significant.ResultsThe basic information of those patients included in the study is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. No statistical significance was found regarding patient age and gender, blood loss during the surgical procedure in those patients who underwent LRN and open RN, as well as in those treated with LPN and open PN. Those patients receiving open RN were more frequently found to be males when compared to those receiving open PN (63.6% and 45.2%, p=0.028). Patients who received open RN had a larger tumor size (5.3 and 4.6cm; p=0.002) and 1.6 days longer postoperative hospital stay (9.2 days and 7.6 days; p<0.001) compared with those who received LRN. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> also shows the standardized complication rates among the 4 procedures, by using the modified Clavien classification system. The overall complication rate was 19.31, 30.04, 35.71 and 36.36% for LRN, open RN, LPN and open PN, respectively.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> illustrates the complication rates for each category. Those complication rates were similar in the case of RN and PN. Gastrointestinal complications were the most common ones among all the complications following nephrectomy (6.82% in the case of LRN, 10.08% for open RN, 11.90% for LPN and 13.90% for open PN). Two patients (0.38%) could not be resuscitated after receiving open RN.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The additional material shows the standardized complication rates among the 4 procedures stratified according to BMI. 11.51% of patients showed obesity, and the overweight rate was 39.50%. 3.91% of patients were underweight. In the case of open RN and open PN, the obese or overweight patients were more frequently men (p<0.001 for open RN; p=0.003 for open PN). The obese patients who received open PN had a 5.6 days longer hospital stay than those patients with normal weight (14.4 days and 8.8 days, p=0.042) (see additional material).In the case of LRN, a moderately decreasing trend was observed in the non-complication rate (87.50, 82.61 and 55.56%, p trend=0.066), as well as a significantly increasing trend in the low-grade complication rate (9.38, 17.39 and 44.44%, p trend=0.027) for those patients with normal weight, overweight and obese ones. The obese patients were 4.471 times more likely to experience low-grade postoperative complications (CI 95%: 1.290–17.422; p=0.031). In open RN we noted a decreasing trend in the non-complication rate (78.90, 67.00 and 49.30%, p trend=0.001), as well as an upward trend in the low-grade complication rate (18.99, 30.00 and 46.68%, p trend<0.001), in the grade I complication rate (7.17, 8.50 and 18.31%, p trend=0.014) and in the grade II complication rate (11.81, 21.50 and 28.17%, p trend<0.001) for those patients with normal weight, overweight and obese ones. The overweight patients were 1.580 times more likely to experience low-grade complications (CI 95%: 1.175–2.818; p=0.006). The difference was even greater in the case of obese patients. These patients were 2.448 times more likely to experience low-grade complications (CI 95%: 1.703–3.518; p<0.001), 2.553 times more likely to experience grade I complications (CI 95%: 1.304–4.997; p=0.005) and 2.384 times more likely to experience grade II complications (CI 95%: 1.433–3.966; p=0.001).Once again, the additional material illustrates the standardized complication rates for these 4 surgical procedures stratified according to hypertension grade. 30.84% patients were diagnosed with hypertension. The patients with hypertension were older than those who did not have it in the case of LRN, open RN and open PN. We found that hypertensive patients who received open RN were less likely to experience any kind of complication in 8.92% of cases (63.91 and 72.83%; OR=0.877; CI 95%: 0.771–0.999; p=0.037), as well as 1.484 times more likely to show low-grade complications (34.91 and 23.53%; OR=1.484; CI 95%: 1.123–1.959; p=0.006) and 1.526 times more likely to develop grade II complications (23.08 and 15.13%; OR=1.526; CI 95%: 1.055–2.206; p=0.026). Likewise, those patients with hypertension and who underwent open PN were 1.929 times more likely to develop low-grade complications (50.00 and 25.93%; OR=1.929; CI 95%: 1.301–2.860; p=0.002) and 2.032 times more likely to experience grade II complications (34.62 and 17.04%; OR=2.032; CI 95%: 1.199–3.443; p=0.009). Furthermore, we found that hypertensive patients who underwent open PN had a 1.3 days longer postoperative hospital stay (10.2 and 8.9 days; p=0.042).The additional material also shows the standardized complication rates among the 4 surgical procedures as stratified by DM. Of the 843 patients, 74 (8.78%) had a diagnosis of DM. The patients with DM were older than those who did not suffer from this disease in LRN, open RN and LPN. We observed that the patients with DM who had undergone open RN were 2.490 times more likely to develop serious, grade I complications (20.83 and 8.37%; OR: 2.490; CI 95%: 331–4.657; p=0.016) and those who received open PN were 4.425 times more likely to experience serious, grade I complications (40.00 and 9.04%; OR: 4.425; CI 95%: 1.815–10.791; p=0.013). In the case of LRN and LPN, the patients with DM showed a similar complication rate when compared with those who did not suffer from DM (see additional material).DiscussionThe main objective of this study was to examine the relationship between obesity, hypertension, as well as DM and the complications arising after nephrectomy. This is precisely the advantage that, in our opinion, our study had when compared with previous studies.As shown in our study, obesity, hypertension and DM were quite frequent among those patients receiving nephrectomy. These chronic metabolic disorders had already become a major public health problem in China. Underweight, overweight and obesity were defined according to the WHO recommendations and the clinical guidelines for obesity control in China, which enabled a more appropriate classification for people from this Asian country. We observed a decreasing trend in the non-complication rate, as well as a growing trend in the low-grade complication rate for both LRN and open RN. This result suggests that a greater BMI, in particular obesity, is associated with a higher complication rate, mainly low-grade ones. A previous study carried out by Gong et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> showed that obesity is related to a higher intra-operative complication rate. Some possible causes may be greater operative difficulty, prolonged operative time and greater intra-operative blood loss. Similar findings have been found for other types of surgery, including breast surgery,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> bowel surgery,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> and open-heart surgery,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> etc.We observed a lower non-complication rate, as well as a higher low-grade complication rate in those patients with hypertension, both in the case of open RN and open PN. Besides, the hypertensive patients who received open PN had a significantly longer postoperative hospital stay. According to our information, this study was the first one to examine the relationship between hypertension and complications after nephrectomy. Hypertension is a chronic medical condition, which forces the heart to work harder than usual so that blood flows through blood vessels. Furthermore, it is a major risk factor for cardiovascular and cerebrovascular diseases. Although this finding was not statistically significant, the prevalence of heart-related complications was moderately higher in hypertensive patients (no data provided). It was assumed that a higher low-grade complication rate might be primarily due to increased heart complications. In the case of LRN, open RN and open PN, the hypertensive patients or those with DM were older. Although several previous studies had shown that age was not significantly related to a higher complication rate after RN or PN,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> this information should be taken into account.In both open RN and open PN, the patients with DM showed a higher grade I complication rate. Some earlier studies had reported that DM was associated with a higher risk for complications in various types of surgery, such as coronary bypass<a class="elsevierStyleCrossRef" href="#bib0115">23</a> and bariatric surgery.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> However, few studies have assessed DM and urological surgeries. DM generally contributes to the development of complications in organs likely to experience microangiopathy. Likewise, it was noted that higher blood glucose level<a class="elsevierStyleCrossRefs" href="#bib0125">25,26</a> was associated with a higher complication rate in certain surgical procedures. We also observed that the patients with DM were older in LRN, open RN and LPN. Nevertheless, most of these patients showed complication rates similar to those who did not suffer from DM, which suggests that age might not play a crucial role in postoperative complications.In our study, increased complication rates corresponded mainly to low-grade ones. In other words, neither obesity, nor hypertension, nor DM would contribute to a greater development of high-grade complications. Since our study included patients from 2006, both open nephrectomy and laparoscopic nephrectomy techniques are well established and properly conducted. Besides, the use of improved technologies regarding anesthesia and postoperative follow-up also help prevent serious complications in patients. However, 2 patients (0.38%) died after receiving open RN. The mortality rate was relatively low when compared to other studies.<a class="elsevierStyleCrossRefs" href="#bib0135">27,28</a> This fact has also been the result of improved related technologies.To conclude, metabolic disorders, such as obesity, hypertension and DM are closely related to a greater number of complications of varying degrees after nephrectomy. As BMI increases, patients are more likely to experience complications after nephrectomy. In the case of obese patients, there is a great risk for developing low-grade complications, as well as grade I and II complications. Hypertensive patients or those suffering from DM are also more likely to develop low-grade complications following nephrectomy. Serious or high-grade complications were exceptional in both RN and PN. Neither obesity, nor hypertension, nor DM would contribute to a greater development of high-grade complications.AuthorshipX. Hua and C. Ying-Ying contributed equally to the completion of this work.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres385818" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec364576" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres385817" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec364577" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient source" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient characteristics" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Primary outcomes" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Authorship" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-06-21" "fechaAceptado" => "2013-09-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec364576" "palabras" => array:5 [ 0 => "Complication" 1 => "Diabetes mellitus" 2 => "Hypertension" 3 => "Nephrectomy" 4 => "Obesity" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec364577" "palabras" => array:5 [ 0 => "Complicación" 1 => "Diabetes mellitus" 2 => "Hipertensión" 3 => "Nefrectomía" 4 => "Obesidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionTo investigate whether obesity, hypertension, and diabetes mellitus (DM) would increase post-nephrectomy complication rates using standardized classification method. MethodsWe retrospectively included 843 patients from March 2006 to November 2012, of whom 613 underwent radical nephrectomy (RN) and 229 had partial nephrectomy (PN). Modified Clavien classification system was applied to quantify complication severity of nephrectomy. Fisher's exact or chi-square test was used to assess the relationship between complication rates and obesity, hypertension, as well as DM. ResultsThe prevalence of obesity, hypertension, and DM was 11.51%, 30.84%, 8.78%, respectively. The overall complication rate was 19.31%, 30.04%, 35.71% and 36.36% for laparoscopic radical nephrectomy (LRN), open-RN, LPN and open-PN respectively. An increasing trend of low grade complication rate as BMI increased was observed in LRN (P=.027) and open-RN (P<.001). Obese patients had greater chance to have low grade complications in LRN (OR=4.471; 95% CI: 1.290–17.422; P=0.031) and open-RN (OR=2.448; 95% CI: 1.703–3.518; P<.001). Patients with hypertension were more likely to have low grade complications, especially grade II complications in open-RN (OR=1.526; 95% CI: 1.055–2.206; P=.026) and open PN (OR=2.032; 95% CI: 1.199–3.443; P=.009). DM was also associated with higher grade I complication rate in open-RN (OR=2.490; 95% CI: 331–4.657; P=.016) and open-PN (OR=4.425; 95% CI: 1.815–10.791; P=.013). High grade complication rates were similar in comparison. ConclusionsObesity, hypertension, and DM were closely associated with increased post-nephrectomy complication rates, mainly low grade complications." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónNuestro objetivo es investigar si la obesidad, la hipertensión y la diabetes mellitus (DM) aumentan la tasa de complicaciones tras nefrectomía empleando métodos de clasificación estandarizados. MétodosIncluimos retrospectivamente 843 pacientes desde marzo de 2006 hasta noviembre de 2012, 613 de los cuales fueron sometidos a nefrectomía radical (NR) y 229 a nefrectomía parcial (NP). Se empleó el sistema de clasificación de Clavien modificado para cuantificar la gravedad de las complicaciones de la nefrectomía. Para evaluar la relación entre las tasas de complicaciones y la obesidad, la hipertensión, así como la DM, se emplearon el test exacto de Fisher y la prueba de Chi cuadrado. ResultadosLa prevalencia de la obesidad, la hipertensión y la DM fue del 11,51, 30,84 y 8,78%, respectivamente. La tasa global de complicaciones fue del 19,31, 30,04, 35,71 y 36,36% para la NR laparoscópica (NRL), la NR abierta, NPL y NP abierta respectivamente. Se observó una tendencia creciente en la tasa de complicaciones leves al aumentar el IMC en la NRL (p=0,027) y en la NR abierta (p<0,001). Los pacientes obesos tenían más probabilidades de sufrir complicaciones leves en la NRL (OR=4,471; IC 95%: 1,290–17,442; p=0,031) y en la NR abierta (OR=2,448; IC 95%: 1,703–3,518; p<0,001). Los pacientes con hipertensión eran más propensos a sufrir complicaciones leves, especialmente complicaciones de grado ii en una NR abierta (OR=1,526; IC 95%: 1,055–2,206; p=0,026) y en una NP abierta (OR=2,032; IC 95%: 1,199–3,443; p=0,009). La DM también se asoció con una mayor tasa de complicaciones de grado i en la NR abierta (OR=2,490; IC 95%: 331–4,657; p=0,016) y en la NP abierta (OR=4,425; IC 95%: 1,815–10,791; p=0,013). En comparación, las tasas de complicaciones severas fueron similares. ConclusionesLa obesidad, la hipertensión y la DM están estrechamente relacionadas con unas tasas más elevadas de complicaciones, principalmente leves, tras nefrectomía." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Hua X, Ying-Ying C, Zu-Jun F, Gang X, Zu-Quan X, Qiang D, et al. La obesidad, la hipertensión y la diabetes mellitus afectan la tasa de complicaciones de las diferentes técnicas de nefrectomía. Actas Urol Esp. 2014;38:640–646." ] 1 => array:3 [ "etiqueta" => "1" "nota" => "These authors contributed equally to this work." "identificador" => "fn1" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0060" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2866 "Ancho" => 2496 "Tamanyo" => 298693 ] ] "descripcion" => array:1 [ "en" => "Rates of complications in each category. (A) Rates of complications in each category in LRN and open RN. (B) Rates of complications in each category in LPN and open PN." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Low grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any deviation from the intraoperative or postoperative course, including the need for pharmacological treatment other than antiemetics, antipyretics, analgesics, diuretics, electrolytes, or physiotherapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complications requiring only the use of intravenous medications, total intravenous nutrition, or blood transfusion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High grade</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IIIa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complications requiring surgery, endoscopic or radiological, under local anesthesia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IIIb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complications requiring surgery, endoscopic or radiological, under local anesthesia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IVa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Life-threatening complications requiring ICU treatment: a single organ dysfunction (including hemodialysis)Life-threatening complications requiring ICU treatment: multiorgan dysfunction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IVb</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death of the patient \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab591268.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Modified Clavien classification system of surgical complications." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RN</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PN</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">LRN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Open RN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">LPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Open PN \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="middle">614</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="middle">229</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">526 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">187 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5±13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.32±12.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.2±14.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.5±13.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55/33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">341/185 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">119/68<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right/left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49/39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">263/263 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21/21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89/98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tumor size (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.3±2.3<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6±1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Length of hospital stay after surgery (d) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.6±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.2±3.9<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.3±3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood loss during the operation (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">235.9±411.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">232.1±379.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">191.1±166.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">231.5±222.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood transfusion during the operation (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.4±224.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.4±322.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.0±86.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.4±115.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab591267.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall complication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">158 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IIIa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade IIIb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade AVI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade VbI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab591266.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "p=0.028." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "p=0.002." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "***" "nota" => "p<0.001." ] ] ] "descripcion" => array:1 [ "en" => "Basic characteristics of the patients." ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 202240 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer statistics, 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Siegel" 1 => "D. Naishadham" 2 => "A. Jemal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3322/caac.20138" "Revista" => array:7 [ "tituloSerie" => "CA Cancer J Clin" "fecha" => "2012" "volumen" => "62" "paginaInicial" => "10" "paginaFinal" => "29" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22237781" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673613621078" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, prevalence and mortality of kidney cancer in Spain: estimates and projections for the 1998–2022 period" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.L. Souza" 1 => "M.M. 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Original article

Obesity, hypertension and diabetes mellitus affect complication rate of different nephrectomy techniques

La obesidad, la hipertensión y la diabetes mellitus afectan la tasa de complicaciones de las diferentes técnicas de nefrectomía

X. Huaa,1, C. Ying-Yingb,1, F. Zu-Juna, X. Ganga, X. Zu-Quana, D. Qianga, J. Hao-Wena,

Corresponding author

haowen_jiang@126.com

Corresponding author.

a Departamento de Urología, Huashan Hospital, Fudan University, Shanghai, PR China

b Departamento de Nefrología, Huashan Hospital, Fudan University, Shanghai, PR China

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rates of complications in each category&#46; &#40;A&#41; Rates of complications in each category in LRN and open RN&#46; &#40;B&#41; Rates of complications in each category in LPN and open PN&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Short-term postoperative outcomes of surgical procedures are generally applied to assess the quality of care offered to the patient&#46; Kidney tumors are one of the most commonly diagnosed types of cancer&#46; In 2012 the estimated number of new cases of renal tumors in the USA was 64&#44;770&#44; thus ranking eighth among all tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain&#44; a rapid upward trend in the incidence&#44; mortality and prevalence of kidney cancer has also been observed in the last ten years&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Over the last few decades&#44; new surgical techniques have been applied for the treatment of renal tumors&#44; such as partial nephrectomy &#40;PN&#41; and laparoscopic surgery&#46; Previous studies have shown that PN can provide equivalent oncologic control as for radical nephrectomy &#40;RN&#41; in renal tumors less than 4<span class="elsevierStyleHsp" style=""></span>cm in diameter&#44; with the benefit of preserving renal function&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Laparoscopic RN &#40;LRN&#41; and laparoscopic PN &#40;LPN&#41; have emerged as minimally invasive alternatives to open surgery&#44; with shorter recovery periods&#44; a shorter postoperative hospital stay and a shorter convalescence time&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Given the westernization of lifestyles and eating habits&#44; both the prevalence of metabolic disorders&#44; as well as hypertension&#44; diabetes mellitus &#40;DM&#41; and obesity are increasing in China and have become a major public health problem&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> Previous studies have provided inconsistent results as to whether hypertension&#44; DM and obesity might increase the postoperative complication rate of nephrectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The Clavien classification system has been proposed in order to determine the complications of surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This system has recently been modified and prospectively validated in a large group of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> We conducted this study with the aim of assessing whether hypertension&#44; diabetes and obesity increase the risk for complications after RN or PN&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient source</span><p id="par0015" class="elsevierStylePara elsevierViewall">After obtaining approval of the Institutional Review Board of Huashan Hospital&#44; Fudan University&#44; Shanghai&#44; China&#44; a retrospective study of medical records from March 2006 to November 2012 was performed to identify all patients who had undergone RN or PN for presumed renal tumor&#46; Patients were excluded from the study in case their BMI&#44; their medical records regarding hypertension or DM&#44; or the pathological&#8211;surgical or postoperative information were not available&#46; We identified a total of 843 patients&#44; 613 of whom had undergone RN &#40;88 had LRN&#44; 526 had open RN&#41; and 229 had undergone PN &#40;42 had LPN&#44; 187 had open PN&#41;&#46; Written consent was given by the patients for their information to be stored in the hospital database and used for research&#46; Both LRN and LPN were performed via the transperitoneal approach in the modified lateral decubitus position&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient characteristics</span><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical information of the patients&#44; such as height&#44; weight&#44; blood pressure&#44; fasting blood glucose level&#44; medical history of hypertension and DM&#44; was collected on admission&#46; DM was defined as pharmacological treatment for type 2 DM&#44; an elevated fasting plasma glucose level &#40;&#8805;7&#46;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#44; or an elevated 2-h postprandial plasma glucose level &#40;&#8805;11&#46;1<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; on admission&#46; Hypertension was defined as pharmacological treatment for hypertension or elevated blood pressure &#40;&#8805;140&#47;90<span class="elsevierStyleHsp" style=""></span>mm Hg&#41; on admission&#46; BMI was calculated &#40;Quetelet index&#41;&#44; which was defined according to the patient&#39;s weight in kilogram divided by their height in meter&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Patients were divided into 4 groups based on the recommendations from the World Health Organization &#40;WHO&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and the clinical guidelines for obesity control in China&#44; including underweight patients&#44; less than 18&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; normal-weight patients from 18&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> to 23&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; overweight patients between 24<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> and 27&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> and obese patients with 28<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> or more&#46; Pathological tumor size was mainly determined by imaging techniques&#46; In the case of those patients without detailed imaging information&#44; the intra-operative size was used&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Pathological profiles were blindly determined by 2 independent pathologists according to the 2004 WHO classification&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Primary outcomes</span><p id="par0025" class="elsevierStylePara elsevierViewall">2 outcomes were assessed in the patients treated with nephrectomy throughout hospitalization or within 30 days following surgery&#44; including&#58; &#40;1&#41; postoperative complications&#59; and &#40;2&#41; mortality&#46; Operative characteristics and complications were prospectively recorded in our renal surgery database&#46; We identified specific ICD-9 codes for acute renal failure&#44; wound complications&#44; postoperative infection&#44; thromboembolic complications&#44; postoperative hemorrhage&#44; neurologic complications and for miscellaneous technical complications related to surgery&#46; Each measure had been previously described by the complications screening program&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In order to be able to quantify surgical complication severity&#44; we applied the standardized method &#40;modified Clavien classification system&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> in order to divide the complications into 5 major categories&#58; grade I&#44; any deviation from the normal intraoperative or postoperative course&#44; including the need for administering pharmacologic treatment other than antiemetics&#44; antipyretics&#44; analgesics&#44; diuretics&#44; electrolytes&#44; or physiotherapy&#59; grade II&#44; complications requiring only the use of intravenous medications&#44; total intravenous nutrition&#44; or blood transfusion&#59; grade III&#44; those complications needing surgical&#44; endoscopic&#44; or radiologic intervention under general anesthesia&#59; grade IVa&#44; life-threatening complications requiring ICU management&#58; single-organ dysfunction or failure &#40;including hemodialysis&#41;&#59; grade IVb&#44; life-threatening complications requiring ICU management&#58; multi-organ dysfunction&#59; grade V&#44; death of the patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Grade I and grade II complications were defined as low-grade complications&#44; and grade III&#44; grade IV and grade V complications as serious or high-grade ones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patient age&#44; tumor size&#44; length of postoperative hospital stay&#44; blood loss during surgery and blood transfusions during operation were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; and a two-way analysis of variance was used to make a comparison among all the groups in the parametric analysis&#46; Non-parametric data&#44; such as sex &#40;male&#47;female&#41;&#44; side of tumor &#40;right&#47;left&#41;&#44; cancer category and complications were evaluated using Fisher&#39;s exact or Chi-square tests&#46; All statistical testing was two-sided&#44; and performed using SPSS version 19&#46;0 for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; Illinois&#44; USA&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The basic information of those patients included in the study is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; No statistical significance was found regarding patient age and gender&#44; blood loss during the surgical procedure in those patients who underwent LRN and open RN&#44; as well as in those treated with LPN and open PN&#46; Those patients receiving open RN were more frequently found to be males when compared to those receiving open PN &#40;63&#46;6&#37; and 45&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#41;&#46; Patients who received open RN had a larger tumor size &#40;5&#46;3 and 4&#46;6<span class="elsevierStyleHsp" style=""></span>cm&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; and 1&#46;6 days longer postoperative hospital stay &#40;9&#46;2 days and 7&#46;6 days&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; compared with those who received LRN&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> also shows the standardized complication rates among the 4 procedures&#44; by using the modified Clavien classification system&#46; The overall complication rate was 19&#46;31&#44; 30&#46;04&#44; 35&#46;71 and 36&#46;36&#37; for LRN&#44; open RN&#44; LPN and open PN&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> illustrates the complication rates for each category&#46; Those complication rates were similar in the case of RN and PN&#46; Gastrointestinal complications were the most common ones among all the complications following nephrectomy &#40;6&#46;82&#37; in the case of LRN&#44; 10&#46;08&#37; for open RN&#44; 11&#46;90&#37; for LPN and 13&#46;90&#37; for open PN&#41;&#46; Two patients &#40;0&#46;38&#37;&#41; could not be resuscitated after receiving open RN&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The additional material shows the standardized complication rates among the 4 procedures stratified according to BMI&#46; 11&#46;51&#37; of patients showed obesity&#44; and the overweight rate was 39&#46;50&#37;&#46; 3&#46;91&#37; of patients were underweight&#46; In the case of open RN and open PN&#44; the obese or overweight patients were more frequently men &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for open RN&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003 for open PN&#41;&#46; The obese patients who received open PN had a 5&#46;6 days longer hospital stay than those patients with normal weight &#40;14&#46;4 days and 8&#46;8 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#41; &#40;see additional material&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the case of LRN&#44; a moderately decreasing trend was observed in the non-complication rate &#40;87&#46;50&#44; 82&#46;61 and 55&#46;56&#37;&#44; <span class="elsevierStyleItalic">p</span> trend<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;066&#41;&#44; as well as a significantly increasing trend in the low-grade complication rate &#40;9&#46;38&#44; 17&#46;39 and 44&#46;44&#37;&#44; <span class="elsevierStyleItalic">p</span> trend<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41; for those patients with normal weight&#44; overweight and obese ones&#46; The obese patients were 4&#46;471 times more likely to experience low-grade postoperative complications &#40;CI 95&#37;&#58; 1&#46;290&#8211;17&#46;422&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#46; In open RN we noted a decreasing trend in the non-complication rate &#40;78&#46;90&#44; 67&#46;00 and 49&#46;30&#37;&#44; <span class="elsevierStyleItalic">p</span> trend<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; as well as an upward trend in the low-grade complication rate &#40;18&#46;99&#44; 30&#46;00 and 46&#46;68&#37;&#44; <span class="elsevierStyleItalic">p</span> trend<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; in the grade I complication rate &#40;7&#46;17&#44; 8&#46;50 and 18&#46;31&#37;&#44; <span class="elsevierStyleItalic">p</span> trend<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41; and in the grade II complication rate &#40;11&#46;81&#44; 21&#46;50 and 28&#46;17&#37;&#44; <span class="elsevierStyleItalic">p</span> trend<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for those patients with normal weight&#44; overweight and obese ones&#46; The overweight patients were 1&#46;580 times more likely to experience low-grade complications &#40;CI 95&#37;&#58; 1&#46;175&#8211;2&#46;818&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; The difference was even greater in the case of obese patients&#46; These patients were 2&#46;448 times more likely to experience low-grade complications &#40;CI 95&#37;&#58; 1&#46;703&#8211;3&#46;518&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; 2&#46;553 times more likely to experience grade I complications &#40;CI 95&#37;&#58; 1&#46;304&#8211;4&#46;997&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; and 2&#46;384 times more likely to experience grade II complications &#40;CI 95&#37;&#58; 1&#46;433&#8211;3&#46;966&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Once again&#44; the additional material illustrates the standardized complication rates for these 4 surgical procedures stratified according to hypertension grade&#46; 30&#46;84&#37; patients were diagnosed with hypertension&#46; The patients with hypertension were older than those who did not have it in the case of LRN&#44; open RN and open PN&#46; We found that hypertensive patients who received open RN were less likely to experience any kind of complication in 8&#46;92&#37; of cases &#40;63&#46;91 and 72&#46;83&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;877&#59; CI 95&#37;&#58; 0&#46;771&#8211;0&#46;999&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;037&#41;&#44; as well as 1&#46;484 times more likely to show low-grade complications &#40;34&#46;91 and 23&#46;53&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;484&#59; CI 95&#37;&#58; 1&#46;123&#8211;1&#46;959&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; and 1&#46;526 times more likely to develop grade II complications &#40;23&#46;08 and 15&#46;13&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;526&#59; CI 95&#37;&#58; 1&#46;055&#8211;2&#46;206&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46; Likewise&#44; those patients with hypertension and who underwent open PN were 1&#46;929 times more likely to develop low-grade complications &#40;50&#46;00 and 25&#46;93&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;929&#59; CI 95&#37;&#58; 1&#46;301&#8211;2&#46;860&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41; and 2&#46;032 times more likely to experience grade II complications &#40;34&#46;62 and 17&#46;04&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;032&#59; CI 95&#37;&#58; 1&#46;199&#8211;3&#46;443&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; Furthermore&#44; we found that hypertensive patients who underwent open PN had a 1&#46;3 days longer postoperative hospital stay &#40;10&#46;2 and 8&#46;9 days&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The additional material also shows the standardized complication rates among the 4 surgical procedures as stratified by DM&#46; Of the 843 patients&#44; 74 &#40;8&#46;78&#37;&#41; had a diagnosis of DM&#46; The patients with DM were older than those who did not suffer from this disease in LRN&#44; open RN and LPN&#46; We observed that the patients with DM who had undergone open RN were 2&#46;490 times more likely to develop serious&#44; grade I complications &#40;20&#46;83 and 8&#46;37&#37;&#59; OR&#58; 2&#46;490&#59; CI 95&#37;&#58; 331&#8211;4&#46;657&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41; and those who received open PN were 4&#46;425 times more likely to experience serious&#44; grade I complications &#40;40&#46;00 and 9&#46;04&#37;&#59; OR&#58; 4&#46;425&#59; CI 95&#37;&#58; 1&#46;815&#8211;10&#46;791&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41;&#46; In the case of LRN and LPN&#44; the patients with DM showed a similar complication rate when compared with those who did not suffer from DM &#40;see additional material&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The main objective of this study was to examine the relationship between obesity&#44; hypertension&#44; as well as DM and the complications arising after nephrectomy&#46; This is precisely the advantage that&#44; in our opinion&#44; our study had when compared with previous studies&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As shown in our study&#44; obesity&#44; hypertension and DM were quite frequent among those patients receiving nephrectomy&#46; These chronic metabolic disorders had already become a major public health problem in China&#46; Underweight&#44; overweight and obesity were defined according to the WHO recommendations and the clinical guidelines for obesity control in China&#44; which enabled a more appropriate classification for people from this Asian country&#46; We observed a decreasing trend in the non-complication rate&#44; as well as a growing trend in the low-grade complication rate for both LRN and open RN&#46; This result suggests that a greater BMI&#44; in particular obesity&#44; is associated with a higher complication rate&#44; mainly low-grade ones&#46; A previous study carried out by Gong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> showed that obesity is related to a higher intra-operative complication rate&#46; Some possible causes may be greater operative difficulty&#44; prolonged operative time and greater intra-operative blood loss&#46; Similar findings have been found for other types of surgery&#44; including breast surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> bowel surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and open-heart surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> etc&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We observed a lower non-complication rate&#44; as well as a higher low-grade complication rate in those patients with hypertension&#44; both in the case of open RN and open PN&#46; Besides&#44; the hypertensive patients who received open PN had a significantly longer postoperative hospital stay&#46; According to our information&#44; this study was the first one to examine the relationship between hypertension and complications after nephrectomy&#46; Hypertension is a chronic medical condition&#44; which forces the heart to work harder than usual so that blood flows through blood vessels&#46; Furthermore&#44; it is a major risk factor for cardiovascular and cerebrovascular diseases&#46; Although this finding was not statistically significant&#44; the prevalence of heart-related complications was moderately higher in hypertensive patients &#40;no data provided&#41;&#46; It was assumed that a higher low-grade complication rate might be primarily due to increased heart complications&#46; In the case of LRN&#44; open RN and open PN&#44; the hypertensive patients or those with DM were older&#46; Although several previous studies had shown that age was not significantly related to a higher complication rate after RN or PN&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> this information should be taken into account&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In both open RN and open PN&#44; the patients with DM showed a higher grade I complication rate&#46; Some earlier studies had reported that DM was associated with a higher risk for complications in various types of surgery&#44; such as coronary bypass<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and bariatric surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> However&#44; few studies have assessed DM and urological surgeries&#46; DM generally contributes to the development of complications in organs likely to experience microangiopathy&#46; Likewise&#44; it was noted that higher blood glucose level<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> was associated with a higher complication rate in certain surgical procedures&#46; We also observed that the patients with DM were older in LRN&#44; open RN and LPN&#46; Nevertheless&#44; most of these patients showed complication rates similar to those who did not suffer from DM&#44; which suggests that age might not play a crucial role in postoperative complications&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our study&#44; increased complication rates corresponded mainly to low-grade ones&#46; In other words&#44; neither obesity&#44; nor hypertension&#44; nor DM would contribute to a greater development of high-grade complications&#46; Since our study included patients from 2006&#44; both open nephrectomy and laparoscopic nephrectomy techniques are well established and properly conducted&#46; Besides&#44; the use of improved technologies regarding anesthesia and postoperative follow-up also help prevent serious complications in patients&#46; However&#44; 2 patients &#40;0&#46;38&#37;&#41; died after receiving open RN&#46; The mortality rate was relatively low when compared to other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> This fact has also been the result of improved related technologies&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">To conclude&#44; metabolic disorders&#44; such as obesity&#44; hypertension and DM are closely related to a greater number of complications of varying degrees after nephrectomy&#46; As BMI increases&#44; patients are more likely to experience complications after nephrectomy&#46; In the case of obese patients&#44; there is a great risk for developing low-grade complications&#44; as well as grade I and II complications&#46; Hypertensive patients or those suffering from DM are also more likely to develop low-grade complications following nephrectomy&#46; Serious or high-grade complications were exceptional in both RN and PN&#46; Neither obesity&#44; nor hypertension&#44; nor DM would contribute to a greater development of high-grade complications&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0100" class="elsevierStylePara elsevierViewall">X&#46; Hua and C&#46; Ying-Ying contributed equally to the completion of this work&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres385818"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusions"
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        1 => array:2 [
          "identificador" => "xpalclavsec364576"
          "titulo" => "Keywords"
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        2 => array:2 [
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          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "M&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
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        3 => array:2 [
          "identificador" => "xpalclavsec364577"
          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patient source"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Patient characteristics"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Primary outcomes"
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              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-06-21"
    "fechaAceptado" => "2013-09-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec364576"
          "palabras" => array:5 [
            0 => "Complication"
            1 => "Diabetes mellitus"
            2 => "Hypertension"
            3 => "Nephrectomy"
            4 => "Obesity"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec364577"
          "palabras" => array:5 [
            0 => "Complicaci&#243;n"
            1 => "Diabetes mellitus"
            2 => "Hipertensi&#243;n"
            3 => "Nefrectom&#237;a"
            4 => "Obesidad"
          ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To investigate whether obesity&#44; hypertension&#44; and diabetes mellitus &#40;DM&#41; would increase post-nephrectomy complication rates using standardized classification method&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We retrospectively included 843 patients from March 2006 to November 2012&#44; of whom 613 underwent radical nephrectomy &#40;RN&#41; and 229 had partial nephrectomy &#40;PN&#41;&#46; Modified Clavien classification system was applied to quantify complication severity of nephrectomy&#46; Fisher&#39;s exact or chi-square test was used to assess the relationship between complication rates and obesity&#44; hypertension&#44; as well as DM&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The prevalence of obesity&#44; hypertension&#44; and DM was 11&#46;51&#37;&#44; 30&#46;84&#37;&#44; 8&#46;78&#37;&#44; respectively&#46; The overall complication rate was 19&#46;31&#37;&#44; 30&#46;04&#37;&#44; 35&#46;71&#37; and 36&#46;36&#37; for laparoscopic radical nephrectomy &#40;LRN&#41;&#44; open-RN&#44; LPN and open-PN respectively&#46; An increasing trend of low grade complication rate as BMI increased was observed in LRN &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;027&#41; and open-RN &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Obese patients had greater chance to have low grade complications in LRN &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;471&#59; 95&#37; CI&#58; 1&#46;290&#8211;17&#46;422&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41; and open-RN &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;448&#59; 95&#37; CI&#58; 1&#46;703&#8211;3&#46;518&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Patients with hypertension were more likely to have low grade complications&#44; especially grade II complications in open-RN &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;526&#59; 95&#37; CI&#58; 1&#46;055&#8211;2&#46;206&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;026&#41; and open PN &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;032&#59; 95&#37; CI&#58; 1&#46;199&#8211;3&#46;443&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#46; DM was also associated with higher grade I complication rate in open-RN &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;490&#59; 95&#37; CI&#58; 331&#8211;4&#46;657&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41; and open-PN &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;425&#59; 95&#37; CI&#58; 1&#46;815&#8211;10&#46;791&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;013&#41;&#46; High grade complication rates were similar in comparison&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Obesity&#44; hypertension&#44; and DM were closely associated with increased post-nephrectomy complication rates&#44; mainly low grade complications&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo es investigar si la obesidad&#44; la hipertensi&#243;n y la diabetes mellitus &#40;DM&#41; aumentan la tasa de complicaciones tras nefrectom&#237;a empleando m&#233;todos de clasificaci&#243;n estandarizados&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Incluimos retrospectivamente 843 pacientes desde marzo de 2006 hasta noviembre de 2012&#44; 613 de los cuales fueron sometidos a nefrectom&#237;a radical &#40;NR&#41; y 229 a nefrectom&#237;a parcial &#40;NP&#41;&#46; Se emple&#243; el sistema de clasificaci&#243;n de Clavien modificado para cuantificar la gravedad de las complicaciones de la nefrectom&#237;a&#46; Para evaluar la relaci&#243;n entre las tasas de complicaciones y la obesidad&#44; la hipertensi&#243;n&#44; as&#237; como la DM&#44; se emplearon el test exacto de Fisher y la prueba de Chi cuadrado&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de la obesidad&#44; la hipertensi&#243;n y la DM fue del 11&#44;51&#44; 30&#44;84 y 8&#44;78&#37;&#44; respectivamente&#46; La tasa global de complicaciones fue del 19&#44;31&#44; 30&#44;04&#44; 35&#44;71 y 36&#44;36&#37; para la NR laparosc&#243;pica &#40;NRL&#41;&#44; la NR abierta&#44; NPL y NP abierta respectivamente&#46; Se observ&#243; una tendencia creciente en la tasa de complicaciones leves al aumentar el IMC en la NRL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; y en la NR abierta &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los pacientes obesos ten&#237;an m&#225;s probabilidades de sufrir complicaciones leves en la NRL &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;471&#59; IC 95&#37;&#58; 1&#44;290&#8211;17&#44;442&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41; y en la NR abierta &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;448&#59; IC 95&#37;&#58; 1&#44;703&#8211;3&#44;518&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los pacientes con hipertensi&#243;n eran m&#225;s propensos a sufrir complicaciones leves&#44; especialmente complicaciones de grado <span class="elsevierStyleSmallCaps">ii</span> en una NR abierta &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;526&#59; IC 95&#37;&#58; 1&#44;055&#8211;2&#44;206&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41; y en una NP abierta &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;032&#59; IC 95&#37;&#58; 1&#44;199&#8211;3&#44;443&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#46; La DM tambi&#233;n se asoci&#243; con una mayor tasa de complicaciones de grado <span class="elsevierStyleSmallCaps">i</span> en la NR abierta &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;490&#59; IC 95&#37;&#58; 331&#8211;4&#44;657&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41; y en la NP abierta &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;425&#59; IC 95&#37;&#58; 1&#44;815&#8211;10&#44;791&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46; En comparaci&#243;n&#44; las tasas de complicaciones severas fueron similares&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La obesidad&#44; la hipertensi&#243;n y la DM est&#225;n estrechamente relacionadas con unas tasas m&#225;s elevadas de complicaciones&#44; principalmente leves&#44; tras nefrectom&#237;a&#46;</p>"
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    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Hua X&#44; Ying-Ying C&#44; Zu-Jun F&#44; Gang X&#44; Zu-Quan X&#44; Qiang D&#44; et al&#46; La obesidad&#44; la hipertensi&#243;n y la diabetes mellitus afectan la tasa de complicaciones de las diferentes t&#233;cnicas de nefrectom&#237;a&#46; Actas Urol Esp&#46; 2014&#59;38&#58;640&#8211;646&#46;</p>"
      ]
      1 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">These authors contributed equally to this work&#46;</p>"
        "identificador" => "fn1"
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0115" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0060"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Rates of complications in each category&#46; &#40;A&#41; Rates of complications in each category in LRN and open RN&#46; &#40;B&#41; Rates of complications in each category in LPN and open PN&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Low grade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grade I</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any deviation from the intraoperative or postoperative course&#44; including the need for pharmacological treatment other than antiemetics&#44; antipyretics&#44; analgesics&#44; diuretics&#44; electrolytes&#44; or physiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grade II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complications requiring only the use of intravenous medications&#44; total intravenous nutrition&#44; or blood transfusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">High grade</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade IIIa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complications requiring surgery&#44; endoscopic or radiological&#44; under local anesthesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade IIIb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complications requiring surgery&#44; endoscopic or radiological&#44; under local anesthesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade IVa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Life-threatening complications requiring ICU treatment&#58; a single organ dysfunction &#40;including hemodialysis&#41;Life-threatening complications requiring ICU treatment&#58; multiorgan dysfunction&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grade IVb</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grade V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Death of the patient&nbsp;\t\t\t\t\t\t\n
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                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Modified Clavien classification system of surgical complications&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">RN</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">PN</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">LRN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Open RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">LPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Open PN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&#46; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="middle">614</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="middle">229</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">526&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&#47;female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#47;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">341&#47;185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#47;68<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right&#47;left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#47;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263&#47;263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#47;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumor size &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Length of hospital stay after surgery &#40;d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood loss during the operation &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">235&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>411&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">232&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>379&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>166&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">231&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>222&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood transfusion during the operation &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">67&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>224&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>322&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>115&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Overall complication&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Low grade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Grade I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Grade II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">High grade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Grade IIIa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Grade IIIb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Grade AVI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Grade VbI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735786
Original language: English

DOI:10.1016/j.acuroe.2014.10.003

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