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Discriminative Ability of Commonly Used Indexes to Predict Adverse Outcomes After Radical Cystectomy: Comparison of
Xiaosong Meng1, Benjamin Press2, Audrey Renson3
1Department of Urology, NYU Langone Health, New York, NY.
Insights
The modified Charlson Comorbidity Index (mCCI) and body mass index (BMI) showed similar, poor predictive ability for complications after radical cystectomy (RC). Combining mCCI and BMI slightly improved prediction for adverse events in bladder cancer surgery.
Area of Science:
- Urology
- Oncology
- Anesthesiology
Background:
- Several comorbidity indexes, including the American Society of Anesthesiologists physical status classification system, modified Charlson Comorbidity Index (mCCI), and modified Frailty Index, are linked to complications after urologic surgery.
- No prior research has directly compared the predictive accuracy of these indexes for postoperative complications specifically following radical cystectomy (RC) for bladder cancer.
Purpose of the Study:
- To evaluate and compare the predictive performance of established comorbidity indexes and demographic factors for postoperative complications after radical cystectomy (RC).
- To identify the most effective tools for predicting adverse outcomes in patients undergoing RC for bladder cancer.
Main Methods:
- A retrospective review of 1516 patients undergoing elective RC for bladder cancer between 2005 and 2011 was conducted using the American College of Surgeons National Surgical Quality Improvement Program database.
- The study assessed outcomes including minor/severe/infectious adverse events, overall adverse events, extended hospital stay, discharge to a higher care level, and mortality.
- Receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were used to determine the discriminative ability of patient comorbidity indexes and demographic data.
Main Results:
- The modified Charlson Comorbidity Index (mCCI) demonstrated the highest predictive value for any adverse event among the comorbidity indexes (AUC, 0.511).
- Demographic factors, specifically body mass index (BMI) and sex, showed comparable predictive ability (AUC, 0.519).
- Overall, all assessed indexes exhibited poor discriminative ability for predicting adverse events (AUC < 0.52), although combining BMI and mCCI offered marginal improvement.
Conclusions:
- For radical cystectomy (RC), patient-derived modified Charlson Comorbidity Index (mCCI), body mass index (BMI), and sex possess similar, albeit poor, discriminative abilities for predicting perioperative adverse outcomes.
- These easily obtainable factors are comparable to more complex tabulated indexes that are less practical for clinical use.
- Both demographic factors and comorbidity indexes demonstrated limited predictive power for adverse events following RC.
Background:
The American Society of Anesthesiologists physical status classification system, modified Charlson Comorbidity Index (mCCI), and modified Frailty Index have been associated with complications after urologic surgery. No study has compared the predictive performance of these indexes for postoperative complications after radical cystectomy (RC) for bladder cancer.
Materials And Methods:
Data from 1516 patients undergoing elective RC for bladder cancer were extracted from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program for a retrospective review. The perioperative outcome variables assessed were occurrence of minor adverse events, severe adverse events, infectious adverse events, any adverse event, extended length of hospital stay, discharge to a higher level of care, and mortality. Patient comorbidity indexes and demographic data were assessed for their discriminative ability in predicting perioperative adverse outcomes using an area under the curve (AUC) analysis from the receiver operating characteristic curves.
Results:
The most predictive comorbidity index for any adverse event was the mCCI (AUC, 0.511). The demographic factors were the body mass index (BMI; AUC, 0.519) and sex (AUC, 0.519). However, the overall performance for all predictive indexes was poor for any adverse event (AUC < 0.52). Combining the most predictive demographic factor (BMI) and comorbidity index (mCCI) resulted in incremental improvements in discriminative ability compared with that for the individual outcome variables.
Conclusion:
For RC, easily obtained patient mCCI, BMI, and sex have overall similar discriminative abilities for perioperative adverse outcomes compared with the tabulated indexes, which are more difficult to implement in clinical practice. However, both the demographic factors and the comorbidity indexes had poor discriminative ability for adverse events.
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