Mp08-05 the Evaluation of Three Validated Comorbidity Indices to Predict Short-Term Postoperative Outcomes After Radical Cystectomy

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP08)1 May 2024MP08-05 THE EVALUATION OF THREE VALIDATED COMORBIDITY INDICES TO PREDICT SHORT-TERM POSTOPERATIVE OUTCOMES AFTER RADICAL CYSTECTOMY Michael Tram, Adrien Bernstein, and Brian Inouye Michael TramMichael Tram , Adrien BernsteinAdrien Bernstein , and Brian InouyeBrian Inouye View All Author Informationhttps://doi.org/10.1097/01.JU.0001008780.87855.57.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy is often performed on patients with multiple comorbidities. Recently, there has been an increase in perioperative clinics to optimize these patients and improve outcomes. Although the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator aids in assessing a patient's preoperative risk, we wanted to see if other commonly used comorbidity indices could be used as a screening tool for patients at risk for postoperative complications. This study examines the ability of the Charlson Comorbidity Index (CCI), Elixhauser/Van Walraven Index (VWI), and modified frailty index (mFI) to predict outcomes after radical cystectomy. METHODS: We identified all patients undergoing radical cystectomy from the State Inpatient Database for Florida (2010-2015) and California (2010-2011). We calculated CCI, VWI, and mFI scores for each patient and extracted 30-day ER services, 30-day inpatient readmissions, and 90-day postoperative complications. We used univariate logistic regression to measure the association of the indices with each outcome. We constructed receiver operating characteristic (ROC) curves and compared area under the curve (AUC) using the VWI as the reference model. RESULTS: We identified 4885 patients. Among these patients, 22.9% (n=1118) had 30-day ER services, 31.5% (n=1538) had 30-day readmissions, and 47.1% (n=2299) had 90-day postoperative complications. On logistic regression, patients in the top quartile of CCI (≥5), VWI (≥10), and mFI (≥0.07) scores had the highest odds of each adverse event. However, ROC curves revealed poor performances predicting adverse outcomes for all three indices (Figure 1). None of the indices achieved an AUC ≥0.60. There were no significant differences between the AUCs for any outcome (p>.05). CONCLUSIONS: While increased CCI, VWI, and mFI scores were associated with increased odds of adverse outcomes, our results demonstrate that these commonly used comorbidity indices are unable to reliably distinguish patients at risk of complications from those who are not. These indices lack a definitive threshold to accurately predict high risk patients who may benefit from perioperative interventions. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e116 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Michael Tram More articles by this author Adrien Bernstein More articles by this author Brian Inouye More articles by this author Expand All Advertisement PDF downloadLoading ...