To test the hypothesis of an association between the American Society of Anesthesiologists (ASA) physical status classification system and the risk of 90-days postoperative complications after robot-assisted radical prostatectomy (RARP), graded using the Clavien-Dindo classification system (CDS). In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. ASA classification was computed by trained anesthesiologists. Postoperative complications at 90 days after RARP were grouped as greater than one (CDS between 2 and 4a) versus up to one (CDS between 0 and 1). The risk association was computed using logistic regression models. According to ASA physical status classification system, patients were distributed as follows: 102 (8.9%) ASA 1, 934 (81.7%) ASA 2, and 107 (9.4%) ASA 3. Overall, 90-days postoperative complications occurred in 277 (24.2%) cases, of which 137 (12%) were graded as CDS 1 vs. 105 (9.2%) CDS 2 vs. 17 (1.5%) CDS 3a vs. 15 (1.3%) CDS 3b vs. 3 (0.3%) CDS 4a. ASA 2 and 3 patient categories were more likely to have 90-days postoperative complications CDS > 1 (12.5% and 16.8%, respectively) compared to ASA 1 patients (4.9%). The risk association was stronger for ASA 3 (odds ratio, [OR]: 4.085; 95%CI: 1.457-11.455; p = 0.007) than for ASA 2 (OR: 2.907; 95%CI: 1.106-7.285; p = 0.023) patient categories. After adjustment for clinical, pathological, and perioperative covariates, including pelvic lymph node dissection (performed vs. not performed), either ASA 2 or 3 categories remained independent predictors of 90-days postoperative complications CDS > 1. The risk of 90-days postoperative complications CDS > 1 after RARP increased as the ASA physical status deteriorated independently by performing or not an extended pelvic lymph node dissection. In the ASA 3 patients category, RARP should be performed at tertiary referral centers to safely manage the risk of postoperative complications.
Journal of robotic surgery. 2022 Nov 27 [Epub ahead of print]
Antonio Benito Porcaro, Riccardo Rizzetto, Alberto Bianchi, Sebastian Gallina, Emanuele Serafin, Andrea Panunzio, Alessandro Tafuri, Clara Cerrato, Filippo Migliorini, Stefano Zecchini Antoniolli, Giovanni Novella, Vincenzo De Marco, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, Enrico Polati, Alessandro Antonelli
Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy. ., Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy., Department of Urology, Vito Fazzi Hospital, 73110, Lecce, Italy., Department of Pathology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy., Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy., Department of Anesthesiology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.