Presented by: Alexander Homer AB
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Introduction

Robotic-assisted laparoscopic prostatectomy (RALP) is the surgical standard of care for localized clinically significant prostate cancer (PCa). The National Surgical Quality Improvement Program (NSQIP) initiated collection of RALP-specific data in 2019. Though RALP boasts a generally low rate of complications, continued assessment of morbidity is necessary for ongoing quality assurance (QA), particularly given a growing trend towards same-day discharge.

Materials

NSQIP was queried for patients with PCa undergoing RALP from 2019-21. Multivariate logistic regression was used to explore the association of risk factors and postoperative complications. Risk factors included ASA class, age, operative time, BMI, and from the extended dataset, PLND, number of nodes evaluated, perioperative antibiotic use (PAU), postoperative VTE prophylaxis use, history of prior pelvic surgery (pPS), and history of prior radiotherapy (pRT). Outcomes included infection, pulmonary embolism (PE), deep venous thrombosis (DVT), acute renal failure, pneumonia, or any surgical complication.

Results

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Among 11,811 patients undergoing RALP, 3.0% (354/11,811) of patients experienced complications. Of the complications, 60% were infections, 20%  PEs, 16.7% DVT, 3.3% acute renal failure, and 10% pneumonia. Factors associated with increased risk of complications were older age, higher BMI, longer operative time, absence of PAU, and pRT. Infection risk was higher among patients with a history of pRT, longer operative time, and higher BMI. PAU only decreased the occurrence of organ space infections. The absence of PAU and higher BMI were associated with a higher risk of PE. Older age was a significant risk factor for DVT. Acute renal failure was more likely in patients with a history of pRT. The absence of PAU was linked to a higher risk of pneumonia.

Conclusion

In recent NSQIP data, RALP has low complication rates, but operative time, BMI, age, pRT, and absence of PAU are associated with postoperative complications.  Accounting for these risk factors and possible future development of predictive tools are important to reduce morbidity and re-presentation in the age of same-day discharge.

Funding

None

Co-Authors

Borivoj Golijanin, BS
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Phillip Schmitt, ScB
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Vikas Bhatt, MD
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Elias S. Hyams, MD
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Gyan Pareek, MD
Brown Medical School