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)

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.