Discussion On The Value Of Modified POSSUM Score In Predicting The Overall Complications After Laparoscopic Radical Cystectomy And Orthotopic Urinary Diversion

Objective(s):Laparoscopic cystectomy and orthotopic urinary diversion involves a wide range of complications,relatively complex,long operation time and old patients with weak ability to deal with the impact of surgery,resulting in a high incidence of postoperative complications.How to objectively and accurately evaluate the risk of surgery,reduce the incidence of postoperative complications and the perioperative mortality have became a major problem that needs to be solved in clinic.In this study,the predictive value of the modified POSSUM scoring system in the total postoperative complications of laparoscopic cystectomy and orthotopic urinary diversion was discussed to provide a quantitative basis for clinical decision-making.Methods:This study retrospectively analyzed the clinical data of 67 patients who were diagnosed with bladder cancer in the department of urology,The Second Affiliated Hospital of Kunming Medical University from January 2018 to October 2019 and underwent laparoscopic cystectomy and orthotopic urinary diversion.Through the improvement of the traditional POSSUM scoring system,the improved POSSUM scoring system was established by adjusting the relevant indexes(including pulmonary infection in the respiratory system evaluation indexes,ECG score was refined,and abdominal contamination was changed to operative field)and the indexes related to postoperative complications in the multivariate Logistic regression analysis Using modified POSSUM scoring system to calculate the incidence of postoperative complications of predicted value,through the area under the receiver-operating characteristic curve(ROC-AUC)modified POSSUM scoring system to evaluate the forecast value and the optimal cut-off point of laparoscopic cystectomy and orthotopic urinary diversion,through the practical example of complications of cases/predict complications numerical(O/E value),judge modified POSSUM scoring system for complications of the discriminant efficiency as a whole.Results:Complications occurred in 38 of the 67 patients,the most common of which was gastrointestinal tract,infection and genitourinary tract related complications,with a relatively low incidence of other complications.Multivariate Logistic regression analysis showed that BMI(OR=2.567,P=0.031),CCI score(OR=15.110,P=0.033)and operation time(OR=1.035,P=0.017)were important risk factors for complications.Complications group BMI was 24.10±1.99 kg/m2,no complications set of BMI was 22.15 ± 1.81 kg/m2(P<0.001),there are complications CCI scores of median 4,no complications set of CCI median score is 2(P<0.001),complications of group operation time was 472.84±77.61 min,no complications group operation time was 364.72 ± 67.47 min(P<0.001),respectively,be included in the physiology hit rating score and surgery,each index according to the severity was divided into four classes,Corresponding scores were 1,2,4 and 8,and an improved POSSUM scoring system was established.The predicted complication rate of the modified POSSUM scoring system was 58.2%,while the actual complication rate was 56.7%.The difference between the two was not statistically significant(P>0.05).The modified POSSUM score was stratified.Although the O/E values of different subgroups were different,the prediction of postoperative complication rate was the best at 41-50%.The traditional POSSUM scoring system had a ROC-AUC of 0.661(P=0.025)for the prediction of complications,while the modified POSSUM scoring system had a ROC-AUC of 0.887(P<0.001)for the prediction of complications,indicating that the modified POSSUM scoring was better than the traditional POSSUM scoring for the prediction of complications in patients with total laparoscopic bladder resection and in situ urinary flow diversion.In addition,the maximum Youden value of the modified POSSUM score was 0.680,and the corresponding ROC curve critical threshold(Cutoff)was 0.384,indicating that if the predicted incidence rate was greater than 38.4%,the patient would have a higher incidence of postoperative complications.Conclusion(s):1.Multivariate Logistic regression analysis of the clinical data of the patients showed that BMI,CCI score and operation time were the main risk factors for complications after laparoscopic cystectomy and orthotopic urinary diversion,and it was of great significance for the prediction of complications to include them in the POSSUM scoring system.2.A new prediction equation was obtained:In(R/1-R)=-21.400+(0.791×PS)+(0.337×OS),R was the incidence of postoperative complications.When R>38.4%,the incidence of postoperative complications in the patient was higher,suggesting that the physician should strengthen perioperative management of the patient3.The modified POSSUM score can accurately predict the incidence of overall complications after laparoscopic cystectomy and orthotopic urinary diversion.4.Patients should be properly screened before surgery,perioperative monitoring and organ support therapy should be strengthened,clinical skills and experience should be improved to reduce the occurrence of complications.