Interest of the POSPOM score in estimating post-operative complication risk after radical cystectomy

Introduction: Identifying patients at risk after cystectomy for cancer is essential. The POSPOM score is a non-specific urological surgery score for estimating post-operative hospital mortality. This study sought to validate the POSPOM score for predicting post-operative morbidity and mortality after cystectomy.Methods: The study retrospectively included all patients undergoing cystectomy for muscle-invasive or locally advanced bladder cancer between 2010 and 2019 in one center. The primary objective was validation of the POSPOM score for calculating severe postoperative morbidity (Clavien-Dindo (CDC)≥3) and 90-day mortality after cystectomy. Secondary objectives were comparison to other predictive scores (Charlson (CCI), ASA).Results: At 90 days, out of 167 patients, 26% (n=44) had a CDC≥3 complication and 8.4% (n=14) had died. POSPOM correlated with the risk of death at 90 days (p<0.001) and postoperative transfusion (p<0.01). Patients with CDC≥3 complications had higher CCI and POSPOM (median 6.5 vs. 5, p<0.01 and 6.49% vs. 5.58%, p=0.029 respectively). Patients who died postoperatively had higher CCI and POSPOM (median 8 vs 6, p<0.001 and 23.9% vs 5.58%, p<0.001 respectively). The prognostic value of the POSPOM score for predicting mortality appears better (AUC=0.886 (0.798-0.973)) compared with CCI (AUC=0.812 (0.710-0.915)) and ASA (AUC=0.739 (0.630-0.849), but not for predicting morbidity.Conclusion: This study confirms the robustness of the POSPOM score for estimating mortality and its limitations for predicting post-operative morbidity.Level of evidence: 3