Association of the Controlling Nutritional Status Score with the Development of Postoperative Paralytic Ileus After Radical Cystectomy: Retrospective Cohort Study.

OBJECTIVE: Postoperative paralytic ileus is a major adverse event of radical cystectomy, causing prolonged hospitalization. The controlling nutritional status score, consisting of serum albumin, total lymphocyte count, and total cholesterol, indicates the nutritional status and may evaluate gastrointestinal status. This study aimed to clarify the association between the controlling nutritional status score and the development of postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder. MATERIALS AND METHODS: We retrospectively analyzed the clinical features of patients who underwent open radical cystectomy or robotic assisted laparoscopic radical cystectomy with ileal conduit or ileal neobladder for bladder cancer between April 2011 and May 2021. The association between clinical variables, including the controlling nutritional status score and the development of postoperative paralytic ileus, was examined. RESULTS: Out of 133 patients, 34 (26%) developed postoperative paralytic ileus. The patients who developed postoperative paralytic ileus were likely to have a higher controlling nutritional status score (P = .055) compared to those who did not develop postoperative paralytic ileus. Multivariate analysis revealed that a preoperative controlling nutritional status score of ≥1 (odds ratio: 2.90, 95% CI: 1.08-7.80, P = .034) and longer operating time (odds ratio: 3.02, 95% CI: 1.13-8.11, P = .027) were significant independent factors for postoperative paralytic ileus development. CONCLUSION: A high controlling nutritional status score and long operating time may be risk factors for developing postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder for bladder cancer. Preoperative controlling nutritional status may be able to predict postoperative paralytic ileus development.

Initial Experience of Hybrid Technique in Robot-Assisted Intracorporeal Ileal Conduit.

OBJECTIVE: This study was designed to describe our hybrid approach to intracorporeal urinary diversion and evaluate surgical experience during initial induction. MATERIAL AND METHODS: Clinical data from 38 patients with bladder cancer undergoing robot-assisted radical cystectomy with ileal conduit hybrid approach to intracorporeal urinary diversion at our institution between May 2020 and January 2022 were reviewed. The hybrid approach to intracorporeal urinary diversion pro cedure involved the following: radical cystectomy, removing a specimen through a 4- to 6-cm skin incision, harvesting an ileal conduit, redocking the robot, and uretero-uretero anastomosis. The relationship between surgical experience and operative time and a Clavien-Dindo classification of grade >3 was evaluated. RESULTS: Of the 38 patients, 30 (79%) were male, and the median age was 75 years (interquartile range, 71-80 years). The total operative time was 384 minutes (interquartile range, 348-409 minutes). The estimated blood loss was 244 mL (interquartile range, 124-445 mL). No bowel injuries or conversions to laparoscopy or laparotomy were encountered. High-grade postoperative complications (Clavien-Dindo classification grade > 3) occurred in 7 cases (19%). The overall 90-day readmission rate following discharge after surgery was 5%. The relationship between surgical experience and operative time was nonlinear. A plateau was not reached in all 38 patients. CONCLUSION: Our hybrid approach to intracorporeal urinary diversion technique can be accomplished safely with acceptable operative times, even with little surgical experience. This procedure might be a safe treat ment option that is relatively easy to perform, particularly in an institution that has not yet introduced intra corporeal urinary diversion. Future randomized trials with larger samples and longer follow-up periods are required to confirm our findings.

Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery.

INTRODUCTION: The purpose of this study was to evaluate whether the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8 are associated with the occurrence of postoperative delirium after major urological cancer surgery. MATERIALS AND METHODS: We retrospectively analyzed a total of 415 consecutive patients who underwent major urologic cancer surgery and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and July 2021. For both the G8 and the IADL-modified G8, a cut-off value of 14 was used. All patients underwent perioperative management according to the Enhanced Recovery After Surgery protocol formulated at our institution. Delirium was diagnosed using the Confusion Assessment Method. The relationship between these screening tests and clinical variables was examined. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). To determine the risk factors for the occurrence of postoperative delirium, univariate and multivariate analyses were performed. RESULTS: Of the 415 patients, 160 (39%) were assigned to the low G8 (score ≤ 14) group and 166 (40%) to the low IADL-modified G8 (score ≤ 14) group. The median age of the patients was 72 years. Postoperative delirium occurred in 31 patients (7%). The AUC values for predicting postoperative delirium were 0.69 for the G8 and 0.71 for the IADL-modified G8. Multivariate analysis for the G8 showed that G8 ≤ 14 (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.2-6.0; P = 0.02), preoperative use of benzodiazepine (OR = 3.8; 95% CI = 1.6-8.6; P = 0.002), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5-7.1; P = 0.003) were independent risk factors for postoperative delirium. Similarly, for the IADL-modified G8, IADL-modified G8 ≤ 14 (OR = 2.6; 95% CI = 1.1-5.8; P = 0.02), preoperative use of benzodiazepine (OR = 3.9; 95% CI = 1.7-8.8; P = 0.001), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5-7.2; P = 0.003) were independent risk factors for postoperative delirium. DISCUSSION: The G8 and the IADL-modified G8 screening may allow for better identification of patients at risk of postoperative delirium.

Value of Geriatric Assessment Using the G8 to Predict Postoperative Urinary Tract Infections in Patients Undergoing Radical Cystectomy.

OBJECTIVE: Urinary tract infection is one of the most common and distressing complications of radical cystectomy with urinary diversion. This study aimed to elucidate the usefulness of the geriatric-8 screening tool for predicting postoperative complications, especially urinary tract infections, in patients who underwent radical cystectomy with urinary diversion. MATERIAL AND METHODS: Ninety-one patients with bladder cancer who underwent radical cystectomy with urinary diversion were assessed for geriatric-8 and classified into 3 groups according to their geriatric-8 score: 14 as the high score group. We retrospectively analyzed the association between geriatric-8 score and postoperative complications classified according to the Clavien-Dindo classification. RESULTS: The median age of the patients was 75 years (interquartile range 71-80 years) and 75 (82%) were male; 41 of the patients (45%) had high geriatric-8 score (>14), 40 of the patients (44%) had intermediate geriatric-8 score (11-14), and 10 of the patients (11%) had low geriatric-8 score (< 11). In multivariate analysis, low score of geriatric-8 was independently associated with the occurrence of grade 2 or higher urinary tract infection within 30 days [odds ratio=5.9; 95% CI=1.2-30.3; P=.03], along with female [odds ratio=6.1; 95% CI=1.7-21.7; P=.006] and open surgery [odds ratio=6.0; 95% CI=1.8-19.6; P=.003]. CONCLUSION: The geriatric-8 score may contribute to predict postoperative urinary tract infection in patients with bladder cancer who underwent radical cystectomy with urinary diversion.