Soliman Christopher, Wuethrich Patrick Y, Walz Jochen, Corcoran Niall M, Lawrentschuk Nathan, Walde Anna, Furrer Marc A
Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur Urol Open Sci. 2025 Apr 28;76:23-37. doi: 10.1016/j.euros.2025.04.002. eCollection 2025 Jun.
This protocol will outline the development of the CAMUS Intra- and Postoperative Risk and Difficulty Estimation Indices (IPRADES), a tool designed to predict perioperative outcomes and surgical complexity in major urological procedures. Its objective will be to enhance preoperative planning and risk stratification by systematically evaluating a range of patient-, organ-, and surgery-specific factors. The study will be conducted in three phases. Firstly, expert consensus will be established through a Delphi survey involving experienced high-volume surgeons to identify key parameters influencing surgical difficulty and complications. Secondly, data will be collected from the CAMUS Collaboration database and augmented with additional parameters from a prospective open cystectomy database. Thirdly, using this extensive dataset, a nomogram will be developed to evaluate the association between the identified parameters and postoperative complications, as well as to quantify their predictive values. Each parameter will be assigned a weighted significance, which will be integrated into the final risk prediction model. Statistical analyses will incorporate multivariable regression models to identify predictors of complications and mortality. The model's performance will be evaluated through c-statistics, Hosmer-Lemeshow tests, and Brier scores, with internal validation performed via dataset splitting and bootstrap resampling. Additionally, the study will compare the predictive accuracy of universal versus procedure-specific models. The tool will not only account for patient and surgical factors, but also incorporate the influence of surgeon experience and learning curves on surgical outcomes. A web-based calculator will be developed to facilitate seamless integration into daily clinical practice, providing real-time risk assessments. Following validation, the CAMUS IPRADES tool will refine surgical planning, optimise resource allocation, and enhance patient counselling. By delivering data-driven risk assessments, it will further enable surgeon and institutional benchmarking, thereby contributing to education, training, and clinical research. Ultimately, this tool will play a pivotal role in advancing the quality and safety of urological surgeries.
本方案将概述CAMUS术中及术后风险与难度评估指数（IPRADES）的开发，这是一种旨在预测主要泌尿外科手术围手术期结果和手术复杂性的工具。其目标是通过系统评估一系列患者、器官和手术特定因素来加强术前规划和风险分层。该研究将分三个阶段进行。首先，通过涉及经验丰富的高容量外科医生的德尔菲调查建立专家共识，以确定影响手术难度和并发症的关键参数。其次，将从CAMUS协作数据库收集数据，并以前瞻性开放性膀胱切除术数据库的其他参数进行补充。第三，利用这个广泛的数据集，开发一个列线图，以评估所确定参数与术后并发症之间的关联，并量化其预测价值。每个参数将被赋予加权显著性，并将其纳入最终的风险预测模型。统计分析将纳入多变量回归模型，以确定并发症和死亡率的预测因素。将通过c统计量、Hosmer-Lemeshow检验和Brier评分评估模型的性能，并通过数据集拆分和自助重采样进行内部验证。此外，该研究将比较通用模型与特定手术模型的预测准确性。该工具不仅将考虑患者和手术因素，还将纳入外科医生经验和学习曲线对手术结果的影响。将开发一个基于网络的计算器，以促进无缝集成到日常临床实践中，提供实时风险评估。经过验证后，CAMUS IPRADES工具将完善手术规划、优化资源分配并加强患者咨询。通过提供数据驱动的风险评估，它还将进一步实现外科医生和机构的基准测试，从而为教育、培训和临床研究做出贡献。最终，该工具将在提高泌尿外科手术的质量和安全性方面发挥关键作用。
