Valerio Massimo, Cerantola Yannick, Fritschi Urs, Hubner Martin, Iglesias Katia, Legris Anne-Sophie, Lucca Ilaria, Vlamopoulos Yannis, Vaucher Laurent, Jichlinski Patrice
Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
Can Urol Assoc J. 2014 Sep;8(9-10):E600-4. doi: 10.5489/cuaj.1848.
Preoperative scores are widely used predictors of complications after major surgery. These scores, however, are not widely used in transurethral procedures. The aim of this study was to assess the value of the Charlson Comorbidity Index (CCI), the age-adjusted CCI, the American Society of Anesthesiologist score (ASA) and the Nutritional Risk Score (NRS) in predicting early morbidity after transurethral urological procedures.
Consecutive patients undergoing transurethral resection of the bladder or the prostate were prospectively enrolled. The scores were calculated preoperatively; 30-day complications were prospectively recorded according to the Dindo-Clavien classification. Univariate logistic regression was performed to investigate the value of each score and of other factors (i.e., age, sex, body mass index, anemia, smoking habit, type of operation and anaesthesia) as predictors of complications. A multivariate model was then calculated using these predictors.
Overall, 197 patients were included. The mean age was 72 (standard deviation ± 10). In total, 26.9% patients had at least 1 complication. Using univariate analysis, we found that each score significantly predicted complications. In multivariate analysis, only the ASA (odds ration [OR] 2.11; 95% confidence interval [CI] 1.01-4.43) and the NRS (OR 2.42; 95% CI 1.56-3.74) remained independent predictors. The best model incorporated ASA, NRS and gender, and predicted morbidity with an area under the curve of 76%. Our study's main limitations are population heterogeneity and limited sample size.
The ASA and the NRS are important and independent determinants of early morbidity after transurethral procedures. The use of these indices may assist clinicians in the decision-making process to balance the possible benefits of transurethral procedures with the potential risks.
术前评分是大手术后并发症的广泛应用的预测指标。然而，这些评分在经尿道手术中并未广泛应用。本研究的目的是评估Charlson合并症指数（CCI）、年龄校正CCI、美国麻醉医师协会评分（ASA）和营养风险评分（NRS）在预测经尿道泌尿外科手术后早期发病率方面的价值。
前瞻性纳入连续接受膀胱或前列腺经尿道切除术的患者。术前计算评分；根据Dindo-Clavien分类前瞻性记录30天并发症。进行单因素逻辑回归以研究每个评分以及其他因素（即年龄、性别、体重指数、贫血、吸烟习惯、手术类型和麻醉）作为并发症预测指标的价值。然后使用这些预测指标计算多变量模型。
总体而言，纳入了197例患者。平均年龄为72岁（标准差±10）。共有26.9%的患者至少发生1种并发症。使用单因素分析，我们发现每个评分都能显著预测并发症。在多因素分析中，只有ASA（比值比[OR]2.11；95%置信区间[CI]1.01-4.43）和NRS（OR 2.42；95%CI 1.56-3.74）仍然是独立的预测指标。最佳模型纳入了ASA、NRS和性别，预测发病率的曲线下面积为76%。本研究的主要局限性是人群异质性和样本量有限。
ASA和NRS是经尿道手术后早期发病率的重要且独立的决定因素。使用这些指标可能有助于临床医生在决策过程中平衡经尿道手术的潜在益处与潜在风险。
