Background

Radical cystectomy (RC) has a high morbidity and leads to a significant socio-economic burden. We aimed to investigate pre-, intra-, and post-operative variables to create a novel score predicting both post-operative clinical (complications) and economic (length of hospital stay) outcome after RC.

Methods

We retrospectively evaluated clinical and histopathological data of 317 patients after RC. We performed univariate and multivariate logistic regression analyses to identify variables associated with post-operative clinical (30-day morbidity according to Clavien–Dindo complications) and economic (length of hospital stay) outcome.

Results

In multivariate analysis, a high number of intraoperative transfusions (T) of packed red blood cells predicted major complications (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.10–2.58, p = 0.017), preoperative potassium (P) level predicted three or more complications (OR for high preoperative potassium 0.71, 95% CI 0.52–0.98, p = 0.037), and high drain (D) loss on post-operative day 1 predicted a longer hospital stay ≥ 22 days (OR 1.57, 95% CI 1.04–2.35, p = 0.003). The PT₂D-Score was able to predict three or more complications (area under the curve: 0.70, 95% CI 0.61–0.78, p < 0.001) and a hospital stay of ≥ 22 days in patients after radical cystectomy (area under the curve: 0.63, 95% confidence interval 0.53–0.72, p = 0.012).

Conclusions

The novel PT₂D-Score combines preoperative potassium level, intraoperative blood transfusion, and post-operative drain loss to predict both clinical (30-day morbidity) and economic (length of hospital stay) outcome for patients undergoing RC. After validation in a larger cohort, the novel PT₂D-Score might serve as an additional criterion to identify patients for intensified monitoring after RC.

中文翻译：

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PT2D评分：一种新颖的工具，可以预测根治性膀胱切除术后的并发症和经济结果。

背景

根治性膀胱切除术（RC）的发病率很高，并导致巨大的社会经济负担。我们旨在调查术前，术中和术后的变量，以创建一个预测RC后RC术后临床（并发症）和经济（住院时间）结果的新评分。

方法

我们回顾性评估了RC后317例患者的临床和组织病理学数据。我们进行了单因素和多因素logistic回归分析，以识别与术后临床（根据Clavien-Dindo并发症的30天发病率）和经济（住院时间）结果相关的变量。

结果

在多变量分析中，大量的充血红细胞术中输注（T）预测了主要并发症（赔率[OR] 1.68，95％可信区间[CI] 1.10–2.58，p  = 0.017），术前钾（P）水平可预测三种或更多种并发症（术前高钾0.71，95％CI 0.52–0.98，p  = 0.037），术后1天流失率高（D）可预测住院时间≥22天（OR 1.57） ，95％CI 1.04–2.35，p  = 0.003）。PT ₂ D评分能够预测三种或更多种并发症（曲线下面积：0.70，95％CI 0.61–0.78，p <0.001）且根治性膀胱切除术后患者住院时间≥22天（曲线下面积：0.63，95％置信区间0.53-0.72，p  = 0.012）。

结论

新型PT ₂ D-Score结合了术前钾水平，术中输血和术后流失量，可预测接受RC的患者的临床（30天发病率）和经济（住院时间）结果。在更大的队列中进行验证后，新型PT ₂ D评分可能会成为识别患者以进行RC后强化监护的附加标准。