The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD)
Abstract Objective The aim of this study was to investigate whether pre‐operative comorbidity status measured by the Charlson comorbidity index (CCI) or cardiopulmonary exercise testing (CPET) is associated with postoperative complications and length of stay (LOS) in patients undergoing robot‐assist...
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | BJUI Compass |
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| Online Access: | https://doi.org/10.1002/bco2.191 |
| _version_ | 1828014633807511552 |
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| author | Arthur McPhee Alexander Ridgway Thomas Bird Raj Pal Edward W. Rowe Anthony J. Koupparis Jonathan J. Aning |
| author_facet | Arthur McPhee Alexander Ridgway Thomas Bird Raj Pal Edward W. Rowe Anthony J. Koupparis Jonathan J. Aning |
| author_sort | Arthur McPhee |
| collection | DOAJ |
| description | Abstract Objective The aim of this study was to investigate whether pre‐operative comorbidity status measured by the Charlson comorbidity index (CCI) or cardiopulmonary exercise testing (CPET) is associated with postoperative complications and length of stay (LOS) in patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD). Patients and methods We conducted a retrospective study of a prospectively maintained database of 428 consecutive patients who underwent RARC‐ICUD at a tertiary referral centre between 2011 and 2019. CCI was correlated with peri‐operative outcomes including postoperative LOS, Clavien–Dindo (CD) complications and survival. A planned subgroup analysis was performed to evaluate the relationship between pre‐operative CPET, and the same outcomes utilising the threshold of anaerobic threshold (AT) ≥ 11/ <11 ml/kg/min were analysed. Results Of the total cohort, 350 patients undergoing RARC‐ICUD with complete data were included in the final analysis. A CCI score ≥5 was associated with a higher rate of CD III–V complications at 30‐day incidence rate ratio (IRR) = 3.033, (p = 0.02) and at 90‐day IRR 2.495, (p = 0.04) postsurgery. LOS was not associated with CCI; the strongest association with LOS was a CD complication of any grading. CCI did not predict readmission or mortality rates after surgery. Subanalyses of patients who underwent pre‐operative CPET found that CPET <11 ml/kg/min did not predict for LOS, CD complications or death within 1 year of surgery. Conclusions CCI score is a simple, reliable and cost‐effective way of identifying patients at increased risk of complication after RARC‐ICUD. Surgeons performing radical cystectomy should consider utilising CCI to augment pre‐operative patient counselling prior to RARC‐ICUD. |
| first_indexed | 2024-04-10T10:04:14Z |
| format | Article |
| id | doaj.art-21965ea72b644005b3082f453e1fb80c |
| institution | Directory Open Access Journal |
| issn | 2688-4526 |
| language | English |
| last_indexed | 2024-04-10T10:04:14Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj.art-21965ea72b644005b3082f453e1fb80c2023-02-16T02:44:43ZengWileyBJUI Compass2688-45262023-03-014218719410.1002/bco2.191The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD)Arthur McPhee0Alexander Ridgway1Thomas Bird2Raj Pal3Edward W. Rowe4Anthony J. Koupparis5Jonathan J. Aning6Bristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UKBristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UKBristol Haematology and Oncology Centre University Hospitals Bristol NHS Foundation Trust Bristol UKBristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UKBristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UKBristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UKBristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UKAbstract Objective The aim of this study was to investigate whether pre‐operative comorbidity status measured by the Charlson comorbidity index (CCI) or cardiopulmonary exercise testing (CPET) is associated with postoperative complications and length of stay (LOS) in patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD). Patients and methods We conducted a retrospective study of a prospectively maintained database of 428 consecutive patients who underwent RARC‐ICUD at a tertiary referral centre between 2011 and 2019. CCI was correlated with peri‐operative outcomes including postoperative LOS, Clavien–Dindo (CD) complications and survival. A planned subgroup analysis was performed to evaluate the relationship between pre‐operative CPET, and the same outcomes utilising the threshold of anaerobic threshold (AT) ≥ 11/ <11 ml/kg/min were analysed. Results Of the total cohort, 350 patients undergoing RARC‐ICUD with complete data were included in the final analysis. A CCI score ≥5 was associated with a higher rate of CD III–V complications at 30‐day incidence rate ratio (IRR) = 3.033, (p = 0.02) and at 90‐day IRR 2.495, (p = 0.04) postsurgery. LOS was not associated with CCI; the strongest association with LOS was a CD complication of any grading. CCI did not predict readmission or mortality rates after surgery. Subanalyses of patients who underwent pre‐operative CPET found that CPET <11 ml/kg/min did not predict for LOS, CD complications or death within 1 year of surgery. Conclusions CCI score is a simple, reliable and cost‐effective way of identifying patients at increased risk of complication after RARC‐ICUD. Surgeons performing radical cystectomy should consider utilising CCI to augment pre‐operative patient counselling prior to RARC‐ICUD.https://doi.org/10.1002/bco2.191bladder cancerCharlson comorbidity indexcomplicationrisk predictionrobot‐assisted radical cystectomy |
| spellingShingle | Arthur McPhee Alexander Ridgway Thomas Bird Raj Pal Edward W. Rowe Anthony J. Koupparis Jonathan J. Aning The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD) BJUI Compass bladder cancer Charlson comorbidity index complication risk prediction robot‐assisted radical cystectomy |
| title | The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD) |
| title_full | The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD) |
| title_fullStr | The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD) |
| title_full_unstemmed | The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD) |
| title_short | The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD) |
| title_sort | impact of cardiopulmonary exercise testing cpet and charlson comorbidity index cci in a large contemporary cohort of patients undergoing robot assisted radical cystectomy and intracorporeal urinary diversion rarc icud |
| topic | bladder cancer Charlson comorbidity index complication risk prediction robot‐assisted radical cystectomy |
| url | https://doi.org/10.1002/bco2.191 |
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