Development of the CAMUS Intra- and Postoperative Risk and Difficulty Estimation Indices Risk Prediction Tool for Estimating Peri- and Postoperative Outcomes, Including Surgical Difficulty, in Major Urological Surgery—A Protocol for a Delphi Study

This protocol will outline the development of the CAMUS Intra- and Postoperative Risk and Difficulty Estimation Indices (IPRADES), a tool designed to predict perioperative outcomes and surgical complexity in major urological procedures. Its objective will be to enhance preoperative planning and risk stratification by systematically evaluating a range of patient-, organ-, and surgery-specific factors. The study will be conducted in three phases. Firstly, expert consensus will be established through a Delphi survey involving experienced high-volume surgeons to identify key parameters influencing surgical difficulty and complications. Secondly, data will be collected from the CAMUS Collaboration database and augmented with additional parameters from a prospective open cystectomy database. Thirdly, using this extensive dataset, a nomogram will be developed to evaluate the association between the identified parameters and postoperative complications, as well as to quantify their predictive values. Each parameter will be assigned a weighted significance, which will be integrated into the final risk prediction model. Statistical analyses will incorporate multivariable regression models to identify predictors of complications and mortality. The model's performance will be evaluated through c-statistics, Hosmer-Lemeshow tests, and Brier scores, with internal validation performed via dataset splitting and bootstrap resampling. Additionally, the study will compare the predictive accuracy of universal versus procedure-specific models. The tool will not only account for patient and surgical factors, but also incorporate the influence of surgeon experience and learning curves on surgical outcomes. A web-based calculator will be developed to facilitate seamless integration into daily clinical practice, providing real-time risk assessments. Following validation, the CAMUS IPRADES tool will refine surgical planning, optimise resource allocation, and enhance patient counselling. By delivering data-driven risk assessments, it will further enable surgeon and institutional benchmarking, thereby contributing to education, training, and clinical research. Ultimately, this tool will play a pivotal role in advancing the quality and safety of urological surgeries.