Moring Nikolas, Tram Michael K, Feustel Paul J, Welliver Charles, Inouye Brian M
Department of Urology, Albany Medical Center, 25 Hackett Blvd, Albany, NY, 12208, USA.
Albany Medical College, Albany, NY, USA.
Int Urol Nephrol. 2025 Jan;57(1):127-134. doi: 10.1007/s11255-024-04199-y. Epub 2024 Sep 6.
To evaluate whether commonly used comorbidity indices [Charlson Comorbidity Index (CCI), Van Walraven Index (VWI), and modified frailty index (mFI)] predict postoperative readmissions and complications after urethroplasty.
Patients undergoing urethroplasty for urethral stricture from the State Inpatient Database and State Ambulatory Surgery and Services Database for Florida (2010-2015) and California (2010-2011) were identified. We calculated CCI, VWI, and mFI scores for each patient. We extracted the following adverse outcomes: 30 day ER services, 30 day inpatient readmissions, and 90 day Clavien-Dindo III-V complications. We constructed receiver operating characteristic (ROC) curves and compared area under the curve (AUC), using the VWI as the reference index.
We identified 908 urethroplasty patients. Among these patients, 11.5% (n = 104) of patients had a complication, with 4.8% (n = 44) specifically having 30-day ER services, 6.2% (n = 56) having 30 day readmissions, and 9.0% (n = 82) having 90-day Clavien-Dindo III-V complications. ROC curves demonstrated poor predictive performances for all four indices as no index achieved an AUC > 0.70. The indices performed similarly poorly but the mFI-DX was particularly poor at predicting 90 day Clavien-Dindo III-V complications (AUC = 0.49; 95% CI 0.43-0.55; p < 0.01).
The CCI, VWI, and mFI have poor ability to identify patients who had an adverse event after urethroplasty. Our results support the need for a urology-specific comorbidity index to better identify at-risk patients undergoing urethroplasty.
评估常用的合并症指数[查尔森合并症指数（CCI）、范瓦尔拉文指数（VWI）和改良虚弱指数（mFI）]是否能预测尿道成形术后的再入院情况和并发症。
从佛罗里达州（2010 - 2015年）和加利福尼亚州（2010 - 2011年）的州住院数据库以及州门诊手术与服务数据库中确定因尿道狭窄接受尿道成形术的患者。我们为每位患者计算CCI、VWI和mFI分数。我们提取了以下不良结局：30天急诊服务、30天住院再入院以及90天Clavien - Dindo III - V级并发症。我们构建了受试者工作特征（ROC）曲线，并以VWI作为参考指数比较曲线下面积（AUC）。
我们确定了908例尿道成形术患者。在这些患者中，11.5%（n = 104）的患者出现并发症，其中4.8%（n = 44）的患者有30天急诊服务，6.2%（n = 56）的患者有30天再入院，9.0%（n = 82）的患者有90天Clavien - Dindo III - V级并发症。ROC曲线显示所有四个指数的预测性能都很差，因为没有一个指数的AUC > 0.70。这些指数的表现同样不佳，但mFI - DX在预测90天Clavien - Dindo III - V级并发症方面尤其差（AUC = 0.49；95% CI 0.43 - 0.55；p < 0.01）。
CCI、VWI和mFI识别尿道成形术后发生不良事件患者的能力较差。我们的结果支持需要一个泌尿外科专用的合并症指数，以更好地识别接受尿道成形术的高危患者。
