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A novel radical prostatectomy specific index (PSI) for the prediction of major cardiovascular events following surgery

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

Prostate cancer patients tend to be older with multiple comorbidities and are thus at increased risk for postoperative cardiovascular events after radical prostatectomy (RP). Thus, proper patient selection strategies are essential to decide for or against a surgical approach. We aimed to derive a prostatectomy specific index (PSI) for patients undergoing RP and compare its performance to universally used indices.

Methods

The cohort was derived from National Surgical Quality Improvement Program database between 2005 and 2012. The primary outcome was incidence of major adverse cardiovascular events at 30 days post-surgery including: death, myocardial infarction, or stroke. A multivariable logistic regression model was constructed, performance and calibration were evaluated using a ROC analysis and the Hosmer–Lemeshow test, the PSI index was derived and compared to the RCRI and AUB-HAS2 indices.

Results

A total of 17,299 patients were included in our cohort, with a mean age of 62 ± 7.4 years. Seventy three patients had a cardiac event post RP. The final PSI index encompassed six variables: history of heart disease, age, anemia, American society of anesthesiology class, surgical approach, and hypertension. The PSI ROC analysis provided C-statistic = 0.72, calibration R2 = 0.99 and proper goodness of fit. In comparison, the C-statistics of RCRI and AUB-HAS2 were found to be 0.57 and 0.65, respectively (p value < 0.001).

Conclusion

The PSI model is a procedure tailored index for prediction of major cardiovascular events post RP. It was calibrated using a large national database aiming to optimize treatment selection strategies for prostate cancer patients.

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Data availability

The (ACS-NSQIP) data is subject to a data use agreement. To access the dataset a request to the ACS-NSQIP participant use form should be placed at the following link (https://www.facs.org/quality-programs/acs-nsqip/participant-use). The American University of Beirut Medical Center is enrolled in ACS-NSQIP as a participating center. As such the data was made available by the ACS-NSQIP center and the AUBMC Department of Surgery after signing the data use agreement.

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Acknowledgements

The ACS NSQIP and the hospitals participating in the ACS -NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon

    Christian H. Ayoub, Jose M. El-Asmar, Nassib F. Abou Heidar & Albert El Hajj

  2. American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon

    Nicolas Najm

  3. Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Ali A. Nasrallah

  4. Clinical Research Institute, American University of Beirut, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon

    Hani Tamim

  5. Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon

    Habib A. Dakik

Authors
  1. Christian H. Ayoub
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Contributions

CA: conceptualized the study, retrieved, and analyzed the data, and wrote/edited the manuscript. JA: conceptualized the study, wrote/edited the manuscript. NFA: conceptualized the study and wrote/edited the manuscript. NN: wrote/edited the manuscript. HD: wrote/edited the manuscript. HT: helped in retrieval and analyzed the data. AEH: project conception/design, manuscript writing/editing.

Corresponding authors

Correspondence to Hani Tamim, Habib A. Dakik or Albert El Hajj.

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The de-identified database (ACS-NSQIP) does not constitute human subject research; therefore, no consent to participate or institutional review board (IRB) approval was required or attained.

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Ayoub, C.H., El-Asmar, J.M., Abou Heidar, N.F. et al. A novel radical prostatectomy specific index (PSI) for the prediction of major cardiovascular events following surgery. Int Urol Nephrol 54, 3069–3078 (2022). https://doi.org/10.1007/s11255-022-03293-3

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