Comparison of different scoring systems for prediction of postoperative complications after robot-assisted radical prostatectomy

Abstract

To evaluate the predictive value of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) score, Comorbidity Score for Robotic Surgery (CRS) and Charlson Comorbidity Index (CCI) in relation to postoperative complications in patients undergoing robot-assisted radical prostatectomy (RARP). A total of 374 patients who underwent RARP were retrospectively analyzed. Patients were divided into two groups based on the presence (n = 50) or absence (n = 324) of postoperative complications, as classified by the Modified Clavien-Dindo system. Demographics, comorbidities, ASA and ECOG scores, perioperative data, E-PASS score, CRS, and CCI scores were compared between groups. Logistic regression analyses were performed to identify independent risk factors for complications, and receiver operating characteristic curves were used to assess the discriminative ability of each scoring system. According to the Clavien-Dindo classification, 60% of complications were Grade 2, followed by Grade 1 (26%) and Grade 3 (8%). Patients with complications had significantly higher rates of hypertension (p = 0.018), diabetes mellitus (p = 0.015), ECOG score (p < 0.001), ASA score (p = 0.02), longer operation time (p = 0.02), higher E-PASS score (p < 0.001) and CRS score (p = 0.007). The CCI did not show a significant difference between the groups (p = 0.54). In the multivariate logistic regression analysis, only the E-PASS score was the independent risk factor for postoperative complications (Odds Ratio: 18.633, 95% CI: 3.644-94.749, p < 0.001). The E-PASS score appears to be an independent risk factor for postoperative complications following RARP, whereas the CRS and CCI failed to show significant prognostic value in this cohort. Integrating E-PASS parameters into preoperative evaluation may enhance postoperative risk stratification and inform patient counseling strategies.

Keywords: CCI score; CRS score; Complications; E-PASS; Robotic prostatectomy.