| Objective:To find relevant factors associated with early complications(within 30-days)of radical cystectomy and intestinal urinary diversion(RC-IUD),especially for the level of albumin and blood glucose)Methods:To summarize RC-IUD in our centre with a deadline of August,2017.All baseline information and perioperative data were collected.All factors which may be related with early complication underwent single-factor analysis.And a further ROC curve was drawn after multi-factor analysis,then we got a final conclusion.Results:(1)We recorded 697 patients of radical cystectomy at our medical centers from June of 2008 to August of 2017.197 patients who were undertaken radical cystectomy plus cutaneous ureterostomy were excluded.451(90.2%)ileal conduits,45(9.0%)Ileal orthotopic neobladders and 4 Mainz pouch bladders(0.8%)were undertaken.Among these 500 RC-IUD patients,255(51.0%)robotic surgeries and 245(49.0%)laparoscopic surgeries were included.We totally have 431 men and 69 women(ration 6.25:1)with a median age of 60 years(interquartile range,IQR,53-67)and median BMI of 24.7 Kg/m2(IQR 22.8-26.7).Besides,median operation time was 5.5h(IQR 5-7),median blood loss 300ml(IQR 200-500),median indwelling gastric tube 4.0 days(IQR 3-7.5),re-insert gastric tube 34 cases,median tolerance time 5 days(IQR 4-6),median postoperative hospital stay 11 days(IQR 9-15)were all definitely recorded.Overall,114 patients(22.8%)encountered a complication after surgery,including Grade I 46 cases(40.4%),Grade ? 58 cases(50.9%),Grade ? 4 cases(3.5%),Grade IV 5 cases(4.4%),Grade V1 cases(0.9%,Dead)which was classified as the standardized Clavien-Dindo scale.In 297 of 500 patients who have complete laboratory tests,preoperative albumin,preoperative blood glucose,postoperative albumin and postoperative blood glucose were all noted respectively.Among the 297 patients,the incidence of complication is 23.2%.(2)Univariate analysis showed that the factors related to postoperative complications were:surgical procedures(?2=5.643,p=0.018),operative time(Z=-3.048,p=0.002),blood loss(Z=-4.682,p<0.01),postoperative A/G(the postoperative ratio of albumin to blood glucose)(Z=-2.007,p=0.045). Multivariate analysis of the above four factors showed that blood loss(p=0.039)and postoperative A/G(p=0.045)were the factors related to postoperative complications.(3)The ROC curve was used to analyze the postoperative A/G.The max Youden index was 0.181,corresponding A/G was 3.62,the specificity was 0.725,and the sensitivity was 0.456.The accuracy of the regression fitting equation was 77.1%.Conclusions:We statistically analyzed the development of laparoscopic and robot-assisted radical cystectomy+intestinal urinary diversion in our hospital by using large sample data.And we found the factors that may affect the occurrence of postoperative early complications were intraoperative blood loss and postoperative ratio of albumin to blood glucose through single-factor and multi-factor analysis.Based on the empirical theory that both albumin and blood glucose may affect the occurrence of complications,as well as the mutual transformation between them.The postoperative A/G is proposed as a possible new predictor rather than an isolated factor which can be used as an index to guide rehabilitation and improve postoperative outcomes. |
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