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The PT2D-Score: a novel tool to predict complications and economic outcome after radical cystectomy

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Abstract

Background

Radical cystectomy (RC) has a high morbidity and leads to a significant socio-economic burden. We aimed to investigate pre-, intra-, and post-operative variables to create a novel score predicting both post-operative clinical (complications) and economic (length of hospital stay) outcome after RC.

Methods

We retrospectively evaluated clinical and histopathological data of 317 patients after RC. We performed univariate and multivariate logistic regression analyses to identify variables associated with post-operative clinical (30-day morbidity according to Clavien–Dindo complications) and economic (length of hospital stay) outcome.

Results

In multivariate analysis, a high number of intraoperative transfusions (T) of packed red blood cells predicted major complications (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.10–2.58, p = 0.017), preoperative potassium (P) level predicted three or more complications (OR for high preoperative potassium 0.71, 95% CI 0.52–0.98, p = 0.037), and high drain (D) loss on post-operative day 1 predicted a longer hospital stay ≥ 22 days (OR 1.57, 95% CI 1.04–2.35, p = 0.003). The PT2D-Score was able to predict three or more complications (area under the curve: 0.70, 95% CI 0.61–0.78, p < 0.001) and a hospital stay of ≥ 22 days in patients after radical cystectomy (area under the curve: 0.63, 95% confidence interval 0.53–0.72, p = 0.012).

Conclusions

The novel PT2D-Score combines preoperative potassium level, intraoperative blood transfusion, and post-operative drain loss to predict both clinical (30-day morbidity) and economic (length of hospital stay) outcome for patients undergoing RC. After validation in a larger cohort, the novel PT2D-Score might serve as an additional criterion to identify patients for intensified monitoring after RC.

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Author notes

  1. M. M. Kamal and H. Borgmann have contributed equally as first authors.

Authors and Affiliations

  1. Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany

    M. M. Kamal, H. Borgmann, C. Schregel, N. D. Nabar, M. Haack, W. Jäger, I. Tsaur, A. Haferkamp & T. Höfner

  2. University Hospital Frankfurt, Frankfurt, Germany

    A. Metzger

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  1. M. M. Kamal
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  2. H. Borgmann
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  3. A. Metzger
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  4. C. Schregel
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  5. N. D. Nabar
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  6. M. Haack
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  7. W. Jäger
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  8. I. Tsaur
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  9. A. Haferkamp
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  10. T. Höfner
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Correspondence to N. D. Nabar.

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Kamal, M.M., Borgmann, H., Metzger, A. et al. The PT2D-Score: a novel tool to predict complications and economic outcome after radical cystectomy. World J Urol 38, 3155–3160 (2020). https://doi.org/10.1007/s00345-020-03129-8

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  • DOI: https://doi.org/10.1007/s00345-020-03129-8

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