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      The impact of cardiopulmonary exercise testing (CPET) and Charlson comorbidity index (CCI) in a large contemporary cohort of patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD)

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          Abstract

          Objective

          The aim of this study was to investigate whether pre‐operative comorbidity status measured by the Charlson comorbidity index (CCI) or cardiopulmonary exercise testing (CPET) is associated with postoperative complications and length of stay (LOS) in patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD).

          Patients and methods

          We conducted a retrospective study of a prospectively maintained database of 428 consecutive patients who underwent RARC‐ICUD at a tertiary referral centre between 2011 and 2019. CCI was correlated with peri‐operative outcomes including postoperative LOS, Clavien–Dindo (CD) complications and survival. A planned subgroup analysis was performed to evaluate the relationship between pre‐operative CPET, and the same outcomes utilising the threshold of anaerobic threshold (AT) ≥ 11/ <11 ml/kg/min were analysed.

          Results

          Of the total cohort, 350 patients undergoing RARC‐ICUD with complete data were included in the final analysis. A CCI score ≥5 was associated with a higher rate of CD III–V complications at 30‐day incidence rate ratio (IRR) = 3.033, ( p = 0.02) and at 90‐day IRR 2.495, ( p = 0.04) postsurgery. LOS was not associated with CCI; the strongest association with LOS was a CD complication of any grading. CCI did not predict readmission or mortality rates after surgery. Subanalyses of patients who underwent pre‐operative CPET found that CPET <11 ml/kg/min did not predict for LOS, CD complications or death within 1 year of surgery.

          Conclusions

          CCI score is a simple, reliable and cost‐effective way of identifying patients at increased risk of complication after RARC‐ICUD. Surgeons performing radical cystectomy should consider utilising CCI to augment pre‐operative patient counselling prior to RARC‐ICUD.

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          Most cited references33

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial

            Radical cystectomy is the surgical standard for invasive bladder cancer. Robot-assisted cystectomy has been proposed to provide similar oncological outcomes with lower morbidity. We aimed to compare progression-free survival in patients with bladder cancer treated with open cystectomy and robot-assisted cystectomy.
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              • Article: not found

              Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy.

              Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity.
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                Author and article information

                Contributors
                jonathan.aning@nbt.nhs.uk
                Journal
                BJUI Compass
                BJUI Compass
                10.1002/(ISSN)2688-4526
                BCO2
                BJUI Compass
                John Wiley and Sons Inc. (Hoboken )
                2688-4526
                07 October 2022
                March 2023
                : 4
                : 2 ( doiID: 10.1002/bco2.v4.2 )
                : 187-194
                Affiliations
                [ 1 ] Bristol Urological Institute, North Bristol NHS Trust Southmead Hospital Bristol UK
                [ 2 ] Department of Urology Addenbrooke's Hospital Cambridge UK
                [ 3 ] Bristol Haematology and Oncology Centre University Hospitals Bristol NHS Foundation Trust Bristol UK
                [ 4 ] Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
                Author notes
                [*] [* ] Correspondence

                Jonathan Aning, Consultant Urological Surgeon and Honorary Associate Professor, Bristol Urological Institute, Bristol, BS9 3TF, UK.

                Email: jonathan.aning@ 123456nbt.nhs.uk

                Author information
                https://orcid.org/0000-0001-6189-4720
                Article
                BCO2191
                10.1002/bco2.191
                9931540
                91c9ea1a-6a23-42e2-8835-ce58e429f37f
                © 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 August 2022
                : 26 May 2022
                : 04 September 2022
                Page count
                Figures: 1, Tables: 6, Pages: 8, Words: 5536
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                March 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.5 mode:remove_FC converted:15.02.2023

                bladder cancer,charlson comorbidity index,complication,risk prediction,robot‐assisted radical cystectomy

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