Bladder Surgery Complications Predicted by New Model
Nomograms specific to radical cystectomy currently do not exist to aid stratification of a patient’s risks for complications.
Up to half of radical cystectomy patients suffer perioperative complications. Now researchers have created a model based on preoperative risk factors that may simplify risk assessment, according to a presentation at the 2017 Genitourinary Cancers Symposium in Orlando, Florida.
Derek Jensen, MD, and colleagues from the University of Kansas Medical Center in Kansas City, Kansas, produced 10 nomogram models using various preoperative factors. The most accurate model had an area under the curve of 0.66. In this model, preoperative risk factors included body mass index (BMI), hypertension, diversion type, biopsy stage, number of comorbidities, and hyperlipidemia.
“Our findings suggest routinely collected preoperative patient-level clinical variables may be useful for determining patient risk for short-term postoperative complications,” Dr Jensen told Renal & Urology News.
He suggested their simple and accessible model may improve upon current, complex risk estimators. “Our next steps would be to validate this prospectively,” he stated. “The vision for this project would be for this nomogram to become a clinical tool used in clinics, perhaps as a phone app for physician-patient counseling of possible cystectomy to enhance shared decision making for pursuing surgery versus bladder-sparing treatment in appropriately selected patients.”
The team reviewed preoperative, intraoperative, and postoperative data for 516 patients who underwent radical cystectomy for bladder cancer at their institution during 2008 and 2016. They examined patients' medical history, pathology from transurethral resection of bladder tumor, preoperative laboratory findings, surgical approach and diversion types, and prior treatments. Separately, complications were ranked according to the Clavien-Dindo scale. The investigators then employed multivariate logistic regression models to find preoperative predictors of major, 90-day postsurgical complications.
See more coverage from the Genitourinary Cancers Symposium.
1. Jensen D, Graw S, Niu S, Glazyrine V, Koestler D, Lee EK. Preoperative risk factors predicting postoperative complications in radical cystectomy for bladder cancer. Data presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida, February 16-18, 2017. Poster Session B (Board #J8). Abstract: 395.