Comparison of Perioperative Risk Assessment Tools for Major Postoperative Complications After Radical Cystectomy

Background/Objectives: To compare the discriminatory performance of commonly used perioperative risk assessment tools, including the American Society of Anesthesiologists (ASA) Physical Status Classification, Estimation of Physiologic Ability and Surgical Stress (E-PASS), Surgical Outcome Risk Tool (SORT), and modified 5-item Frailty Index (mFI-5), for major postoperative complications after radical cystectomy.

Methods

This retrospective observational study included 193 patients who underwent open radical cystectomy for bladder cancer between January 2017 and January 2025. Major postoperative complications were defined as Clavien–Dindo grade III or higher. The discriminatory performance of ASA, E-PASS Comprehensive Risk Score (CRS), SORT, and mFI-5 was assessed using receiver operating characteristic analysis. Pairwise comparisons of the areas under the receiver operating characteristic curves (AUCs) were performed using the DeLong test. Logistic regression models were used to evaluate associations with major complications, and exploratory analyses examined secondary postoperative outcomes.