Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.
Urol Oncol. 2019 Apr;37(4):291.e9-291.e18. doi: 10.1016/j.urolonc.2018.12.013. Epub 2019 Jan 9.
To optimize complication reporting in patients undergoing cystectomy and urinary diversion (UD) using the Comprehensive Complication Index (CCI). The original CCI ranging from 0 (no complications) to 100 (death) integrates all complications weighted by severity over time in a single formula. However, due to the large number of complications after cystectomy and UD, the CCI may exceed the upper limit.
In an observational single-center cohort, 90-day postoperative complications in 1,313 consecutive patients undergoing cystectomy and UD from 2000 to 2017 were evaluated. Prospectively collected complications were graded according to the Clavien-Dindo classification (CDC). A modified Berne CCI was developed using an exponential function, which transforms the sum of the weights into a value between 0 and 100. The correlation between the Berne and original CCI values was depicted graphically. Finally, original CCI and Berne CCI values for each patient were extracted and compared. Predictive values of CCI scores for mortality or severe complications (CDC ≥IV) within 1 year postoperatively were investigated by use of multiple logistic regression analyses.
Overall complication rate was 82%, with CDC grade I to II in 56% and CDC grade IIIa to V in 27% respectively. Applying the original CCI, the upper limit was exceeded in 8 patients, with a maximal value of 119.1 (median 25.7 [interquartile range: 20.9-37.2]). The maximal value of the Berne CCI was 99.4 (21.2 [14.6-39.3]) for nondeath cases. The Berne CCI predicted the onset of death and severe complications between postoperative day 91 and 365 (both P <0.0001), whereas the original CCI was only predictive in interaction with other variables but not alone (P = 0.2772 and P = 0.0862, respectively).
The optimized Berne CCI depicts postoperative morbidity and burden within 90 days after cystectomy and UD without exceeding the upper index limit. It is specifically suited for longitudinal assessment of complications after cystectomy and UD taking into consideration every single complication and corresponding treatment. As the Berne CCI well predicted the onset of mortality and severe complications within 1 year postoperatively, this may allow a better preoperative patient counselling. It therefore warrants consideration for standardized reporting of complications after cystectomy and UD.
利用综合并发症指数（CCI）优化接受膀胱切除术和尿流改道术（UD）患者的并发症报告。原始 CCI 范围从 0（无并发症）到 100（死亡），通过单一公式随时间将所有严重程度加权的并发症进行整合。然而，由于膀胱切除术和 UD 后并发症数量众多，CCI 可能会超过上限。
在一项观察性单中心队列研究中，评估了 2000 年至 2017 年间连续 1313 例接受膀胱切除术和 UD 的患者的 90 天术后并发症。根据 Clavien-Dindo 分类（CDC）对前瞻性收集的并发症进行分级。使用指数函数开发了改良的伯尔尼 CCI，该函数将权重之和转换为 0 到 100 之间的值。图形化描绘了伯尔尼 CCI 和原始 CCI 值之间的相关性。最后，提取并比较了每位患者的原始 CCI 和伯尔尼 CCI 值。使用多元逻辑回归分析研究 CCI 评分对术后 1 年内死亡率或严重并发症（CDC ≥IV）的预测价值。
总体并发症发生率为 82%，CDC 分级 I 至 II 级占 56%，CDC 分级 IIIa 至 V 级占 27%。应用原始 CCI，8 例患者超过上限，最大值为 119.1（中位数 25.7[四分位距：20.9-37.2]）。非死亡病例的伯尔尼 CCI 最大值为 99.4（21.2[14.6-39.3]）。伯尔尼 CCI 预测术后第 91 天至 365 天之间的死亡和严重并发症的发生（均 P<0.0001），而原始 CCI 仅在与其他变量相互作用时具有预测作用，而不是单独具有预测作用（P=0.2772 和 P=0.0862，分别）。
改良的伯尔尼 CCI 描述了膀胱切除术和 UD 后 90 天内的术后发病率和负担，而不会超过上限指数。它特别适合于考虑每个单独的并发症和相应的治疗措施，对膀胱切除术和 UD 后进行长期并发症评估。由于伯尔尼 CCI 很好地预测了术后 1 年内的死亡率和严重并发症的发生，因此可以更好地进行术前患者咨询。因此，它值得考虑用于膀胱切除术和 UD 后并发症的标准化报告。
