Wang Yiduo, Lu Xun, Gao Yue, Liu Ning, Jiang Hua, Chen Shuqiu, Chen Ming
Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China.
Front Surg. 2022 Nov 16;9:985292. doi: 10.3389/fsurg.2022.985292. eCollection 2022.
The purpose of the study was to evaluate the predictive value of prognostic nutritional index (PNI) on early complications (within 30-day) after robot-assisted radical cystectomy (RARC) and urinary diversion.
Patients underwent RARC and urinary diversion between November 2018 and December 2021 in our centre were screened in this retrospective study. Baseline characteristics and perioperative data were recorded. Early complications after surgery were classified according to Clavien-Dindo system. Univariate and multivariate logistic analysis were performed to decide the potential factors associated with post-RARC complications. The receiver operating characteristic (ROC) curve was conducted to determine the predictive value of PNI on early overall and major complications after RARC.
Overall 139 men and 13 women with a median age of 69 years and mean BMI of 24.4 kg/m were included in this study. As for urinary diversion, most patients ( = 111, 73%) received cutaneous ureterostomy, 36 patients (23.7%) underwent orthotopic neobladder and 5 patients (3.3%) received ileal conduit. The incidence of postoperative complication rate was 44.7%, which included 82.2% minor complications and 17.8% major complications. Further univariate and multivariate logistic analyses demonstrated that hypertension (OR = 2.96, 95% CI: 1.24-7.07, = 0.015), PNI (OR = 0.73, 95% CI: 0.62-0.86, < 0.001), and CCI (OR = 1.44, 95% CI: 1.01-2.06, = 0.047) were independent risk factors of early complications after RARC. Moreover, PNI (OR = 0.72, 95% CI: 0.60-0.86, < 0.001) was also the predictor of major complications after RARC. The ROC curve demonstrated that PNI (AUC = 0.829; AUC = 0.840) has a great predictive value in early overall and major complications after RARC.
PNI can be an early alert for RARC patients thus aiding in closer monitoring and postoperative management.
本研究旨在评估预后营养指数（PNI）对机器人辅助根治性膀胱切除术（RARC）及尿流改道术后早期并发症（30天内）的预测价值。
本回顾性研究纳入了2018年11月至2021年12月在我院接受RARC及尿流改道的患者。记录基线特征和围手术期数据。术后早期并发症根据Clavien-Dindo系统进行分类。进行单因素和多因素逻辑回归分析以确定与RARC术后并发症相关的潜在因素。绘制受试者工作特征（ROC）曲线以确定PNI对RARC术后早期总体并发症和主要并发症的预测价值。
本研究共纳入139例男性和13例女性，中位年龄69岁，平均BMI为24.4 kg/m。至于尿流改道，大多数患者（n = 111，73%）接受皮肤输尿管造口术，36例患者（23.7%）接受原位新膀胱术，5例患者（3.3%）接受回肠膀胱术。术后并发症发生率为44.7%，其中轻微并发症占82.2%，严重并发症占17.8%。进一步的单因素和多因素逻辑回归分析表明，高血压（OR = 2.96，95%CI：1.24 - 7.07，P = 0.015）、PNI（OR = 0.73，95%CI：0.62 - 0.86，P < 0.001）和CCI（OR = 1.44，95%CI：1.01 - 2.06，P = 0.047）是RARC术后早期并发症的独立危险因素此外，PNI（OR = 0.72，95%CI：0.60 - 0.86，P < 0.001）也是RARC术后主要并发症的预测指标。ROC曲线表明，PNI（AUC = 0.829；AUC = 0.840）对RARC术后早期总体并发症和主要并发症具有较高的预测价值。
PNI可为RARC患者提供早期预警，有助于加强监测和术后管理。
