Miles P Mannas1,2, Taeweon Lee1, Connor M Forbes1, Tracey Hong3, Andrea Bisaillon4, Martin E Gleave1,2, Alan I So1,2, Kelly Mayson5, Peter C Black6,7. 1. Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada. 2. Vancouver Prostate Centre, Vancouver, BC, Canada. 3. Operations Director, Surgery, Vancouver General Hospital, Vancouver, Canada. 4. Clinical Quality and Patient Safety Department, Vancouver General Hospital, Vancouver, Canada. 5. Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada. 6. Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada. pblack@mail.ubc.ca. 7. Vancouver Prostate Centre, Vancouver, BC, Canada. pblack@mail.ubc.ca.
Abstract
INTRODUCTION: Radical cystectomy (RC) is a challenging procedure with significant morbidity, though remains the standard of care treatment for many patients with bladder cancer. There has been debate regarding the utility of universal risk calculators to aid in point-of-care prediction of complications in individual patients preoperatively. We retrospectively evaluated the predictive value of the ACS NSQIP universal surgical risk calculator in our patients who underwent RC. METHODS: A prospective cohort of patients undergoing RC was retrospectively reviewed between October 2014 and August 2017. Only patients who underwent a RC for genitourinary cancer without significant deviation from NSQIP surgery codes 51590, 51595, and 51596 (n = 29) were included. The accuracy of the risk calculator was assessed by ROC AUC and Brier scores for both NSQIP and Clavien-Dindo defined complications. Additionally, each NSQIP risk factor was individually assessed for association with postoperative complications. RESULTS: 223 patients who underwent open or robotic RC (n = 18) were included for analysis. Determined by AUC C-stat and Brier scores, prediction was good for cardiac complications (0.80 and 0.021), fair for pneumonia (0.75 and 0.017), poor for UTI (0.64 and 0.078), 30-day mortality (0.62 and 0.013), any complication (0.60 and 0.19) and serious complication (0.60 and 0.17). There was a significant discordance between the rate of NSQIP predicted vs. Clavien-Dindo observed any and serious complications: 28.8% vs. 67.3%, and 25.3% vs. 11.7%, respectively. CONCLUSION: The NSQIP universal surgical risk calculator did not perform with enough accuracy to consider adoption into clinical practice.
INTRODUCTION: Radical cystectomy (RC) is a challenging procedure with significant morbidity, though remains the standard of care treatment for many patients with bladder cancer. There has been debate regarding the utility of universal risk calculators to aid in point-of-care prediction of complications in individual patients preoperatively. We retrospectively evaluated the predictive value of the ACS NSQIP universal surgical risk calculator in our patients who underwent RC. METHODS: A prospective cohort of patients undergoing RC was retrospectively reviewed between October 2014 and August 2017. Only patients who underwent a RC for genitourinary cancer without significant deviation from NSQIP surgery codes 51590, 51595, and 51596 (n = 29) were included. The accuracy of the risk calculator was assessed by ROC AUC and Brier scores for both NSQIP and Clavien-Dindo defined complications. Additionally, each NSQIP risk factor was individually assessed for association with postoperative complications. RESULTS: 223 patients who underwent open or robotic RC (n = 18) were included for analysis. Determined by AUC C-stat and Brier scores, prediction was good for cardiac complications (0.80 and 0.021), fair for pneumonia (0.75 and 0.017), poor for UTI (0.64 and 0.078), 30-day mortality (0.62 and 0.013), any complication (0.60 and 0.19) and serious complication (0.60 and 0.17). There was a significant discordance between the rate of NSQIP predicted vs. Clavien-Dindo observed any and serious complications: 28.8% vs. 67.3%, and 25.3% vs. 11.7%, respectively. CONCLUSION: The NSQIP universal surgical risk calculator did not perform with enough accuracy to consider adoption into clinical practice.
Authors: Łukasz Zapała; Aleksander Ślusarczyk; Bartłomiej Korczak; Paweł Kurzyna; Mikołaj Leki; Piotr Lipiński; Jerzy Miłow; Michał Niemczyk; Kamil Pocheć; Michał Późniak; Maciej Przudzik; Tomasz Suchojad; Rafał Wolański; Piotr Zapała; Tomasz Drewa; Marek Roslan; Waldemar Różański; Andrzej Wróbel; Piotr Radziszewski Journal: Front Oncol Date: 2022-01-26 Impact factor: 6.244