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Predicting complications following radical cystectomy with the ACS NSQIP universal surgical risk calculator

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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.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada

    Miles P. Mannas, Taeweon Lee, Connor M. Forbes, Martin E. Gleave, Alan I. So & Peter C. Black

  2. Vancouver Prostate Centre, Vancouver, BC, Canada

    Miles P. Mannas, Martin E. Gleave, Alan I. So & Peter C. Black

  3. Department of Anesthesia, Vancouver General Hospital, Vancouver, BC, Canada

    Kelly Mayson

  4. Operations Director, Surgery, Vancouver General Hospital, Vancouver, Canada

    Tracey Hong

  5. Clinical Quality and Patient Safety Department, Vancouver General Hospital, Vancouver, Canada

    Andrea Bisaillon

Authors
  1. Miles P. Mannas
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  2. Taeweon Lee
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  3. Connor M. Forbes
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  4. Tracey Hong
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  6. Martin E. Gleave
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  7. Alan I. So
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  8. Kelly Mayson
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  9. Peter C. Black
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Contributions

MPM: project development, data management, data analysis, and manuscript writing. TL: data collection. CF: data collection. TH: data collection. AB: data collection. MEG: project development. AIS: project development. KM: project development. PCB: protocol/project development, data analysis, and manuscript editing.

Corresponding author

Correspondence to Peter C. Black.

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Conflict of interest

MP Mannas, T. Lee, CM Forbes, T. Hong, A. Bisaillon, and AI So declare that they have no conflict of interest. ME Gleave has the following disclosures: consultant for Abbvie, Astellas, Amgen, AstraZeneca, Bayer, GDx, Janssen, MDx, Pfizer, Sanofi; advisory boards for Astellas, Sanofi, Janssen, AstraZeneca, Bayer; honorarium from Astellas, Sanofi, Janssen, Bayer, Pfizer; research grants from Janssen, Astellas, Amgen; patents OGX-011, OGX-427; founder of OncoGenex Technologies. K Mayson is on a speaker’s board for 3 M Canada and advisory council for Edwards Lifesciences Canada. PC Black has the following disclosures: research grants from iProgen, GenomeDx, and Sitka; medical advisory boards for Abbvie, Astellas Pharma, Janssen Oncology, Amgen, Bayer, Merck, Sanofi Canada, Biosyent, Ferring, Roche Canada, MDxHealth, AstraZeneca and Urogen pharma.

Ethical approval

All data collection of this retrospective study is in accordance with the ethical standards and/or national health committee (UBC Clinical Research Ethics Board, H17-02508) and with the 1964 Helsinki declaration and its later amendments or comparable ethics standards. Due to the retrospective nature of the study, informed consent was not required by the clinical research ethics board.

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Mannas, M.P., Lee, T., Forbes, C.M. et al. Predicting complications following radical cystectomy with the ACS NSQIP universal surgical risk calculator. World J Urol 38, 1215–1220 (2020). https://doi.org/10.1007/s00345-019-02915-3

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  • DOI: https://doi.org/10.1007/s00345-019-02915-3

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