A new index (A/G) associated with early complications of radical cystectomy and intestinal urinary diversion

Abstract

Objectives: To put forward a new index (A/G, the postoperative ratio of albumin to blood glucose) associated with complications occurring within 30-day of radical cystectomy and intestinal urinary diversion (RC-IUD).

Patients and methods: The charts of 565 patients undergoing RC-IUD at our single center between 2008 and 2018 were reviewed. All baseline information and perioperative data were collected. We finally picked up 360 of them with complete postoperative laboratory test results to find a new index. Early complications (within 30-day) after surgery were graded using the standardized Clavien-Dindo scale. Single and multivariate logistic regression determined the association between perioperative variables and post RC-IUD complications.

Results: A total of 485 men and 80 women with a median age of 61 years and BMI of 24.8 were included. As for intestinal urinary diversion, most patients (n = 513, 90.8%) received ileal conduits, 47 (8.3%) received Ileal orthotopic neobladders and 5 received Mainz pouch bladders (0.9%). Robotic surgeries were conducted in 311(55.0%) patients and other 254 (45.0%) accepted laparoscopic surgeries. Available laboratory markers were obtained from 359 cases. Postoperative complications occurred in 129 patients (22.8%), including 117 (90.7%) Minor (Clavien I or Clavien II events) complications, and 12 (9.3%) major (Clavien III or greater events) complications. A single logistic regression identified 4 variables associated with postoperative complications, including hypertension, surgical procedures, postoperative A/G, operating time, and blood loss. A further multivariate logistic regression identified 2 significant indices: operating time and postoperative A/G. Moreover, we built a receiver operating characteristic curve of A/G to identify a threshold of 3.65 as a new indicator of postoperative complication.

Conclusions: We put forward a new index named A/G associated with complications after radical cystectomy, not singular considering albumin or blood glucose any more. This novel related index may provide an early alert for RC-IUD patients thus aiding in directing individual rehabilitation and improving postoperative outcomes after RC-IUD.

Keywords: Albumin; Blood glucose; Early complications; Intestinal urinary diversion; Radical cystectomy.