背景:这项研究评估了生理能力和手术压力评估(E-PASS)评分系统在预测根治性膀胱切除术(RC)后并发症中的有效性。
方法:在这项单中心回顾性研究中,我们分析了在2008年至2023年期间由一名外科医生进行的肌层浸润性膀胱癌开放RC治疗的患者的数据.排除涉及非尿路上皮癌或除回肠导管以外的尿路改道的膀胱切除术的病例。我们记录了病人的人口统计,体重指数(BMI),腹部/腹膜后手术史,ASA得分,性能状态(PS),和预先存在的条件,如高血压(HT),冠状动脉疾病(CAD),糖尿病(DM),慢性肾病(CKD)。术中数据包括手术时间,失血,需要输血.使用Clavien-Dindo系统对术后并发症进行分类。使用术前风险评分(PRS)计算E-PASS评分,手术应激评分(SSS),和综合风险评分(CRS)。
结果:该研究包括252名患者。术后出现并发症的患者年龄较高,BMI,既往手术史,ASA得分,PS,和CAD的比率,HT,DM,和CKD相比,那些没有。手术持续时间,失血,输血需求,和E-PASS分数(PRS,SSS,CRS)在该组中也较高。CRS的ROC曲线显示0.4911的预测性截止值(AUC=0.905,p<0.001)。术后并发症的独立危险因素包括高BMI(p=0.031),手术时间更长(p<0.001),HT(p=0.042),CKD(p=0.017),CRS>0.4911(p<0.001)。
结论:E-PASS系统可有效预测RC患者术后并发症。
BACKGROUND: This study evaluates the effectiveness of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system in predicting postoperative complications following radical cystectomy (RC).
METHODS: In this single-center retrospective study, we analyzed data from patients who underwent open RC for muscle-invasive bladder cancer by a single surgeon between 2008 and 2023. Cases involving cystectomy for non-urothelial carcinoma or urinary diversion other than ileal conduit were excluded. We recorded patient demographics, body mass index (BMI), history of abdominal/retroperitoneal surgery, ASA score, performance status (PS), and pre-existing conditions, such as hypertension (HT), coronary artery disease (CAD), diabetes mellitus (DM), and chronic kidney disease (CKD). Intraoperative data included surgery duration, blood loss, and need for blood transfusion. Post-operative complications were classified using the Clavien-Dindo system. E-PASS score was calculated using the Preoperative Risk Score (PRS), Surgical Stress Score (SSS), and Comprehensive Risk Score (CRS).
RESULTS: The study included 252 patients. Patients who experienced postoperative complications had higher age, BMI, prior surgical history, ASA score, PS, and rates of CAD, HT, DM, and CKD compared to those who did not. Surgery duration, blood loss, blood transfusion requirement, and E-PASS scores (PRS, SSS, CRS) were also higher in this group. The ROC curve for CRS revealed a predictive cutoff of 0.4911 (AUC = 0.905, p < 0.001). Independent risk factors for postoperative complications included high BMI (p = 0.031), longer surgery duration (p < 0.001), HT (p = 0.042), CKD (p = 0.017), and CRS > 0.4911 (p < 0.001).
CONCLUSIONS: E-PASS system effectively predicts postoperative complications in RC patients.