Prediction of postoperative complications after robotic radical cystectomy: comparison of four preoperative scores.

Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has become a standard option for muscle-invasive bladder cancer, although perioperative morbidity remains substantial. This retrospective study evaluated four preoperative scores - American Society of Anesthesiology physical status (ASA), Estimation of Physiologic Ability and Surgical Stress (E-PASS), Preoperative Score to Predict Postoperative Mortality (POSPOM), and Surgical Outcome Risk Tool (SORT) - to determine their ability to predict postoperative complications in 115 patients undergoing RARC. Logistic regression analyses demonstrated that E-PASS and operative time were the most significant predictors. A 0.01-point increase in E-PASS was associated with a 2.7% higher risk of complications, while each additional 10 min of operative time resulted in an 8% increase in risk. In contrast, ASA and POSPOM showed predictive value only when adjusted for operative time, and SORT did not demonstrate statistical significance. These findings indicate that integrating physiological reserve and surgical stress, as reflected in E-PASS, provides superior perioperative risk stratification in RARC. Additionally, the results highlight the importance of minimizing operative time, underscoring the role of surgical expertise and procedural efficiency in improving postoperative outcomes.