Factors Associated with Postoperative Complications from Robotic-Assisted Laparoscopic Radical Prostatectomy in Contemporary NSQIP Data
Alexander Homer, B.A.1, Borivoj Golijanin, B.S.2, Phillip Schmitt, B.S.1, Vikas Bhatt, M.D.3, Elias S. Hyams, M.D.3.
1Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA, 3Department of Urology, The Warren Alpert Medical School of Brown University; Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA.
BACKGROUND: For localized clinically significant prostate cancer (csPCa), robotic-assisted laparoscopic prostatectomy (RALP) is a gold standard treatment. Despite a low overall complication rate, continued quality assurance (QA) efforts to minimize complications of RALP are important, particularly given movement toward same-day discharge. In 2019, NSQIP began collecting RALP-specific data. In this study, we assessed pre- and perioperative factors associated with postoperative complications for RALP to further QA efforts. METHODS: NSQIP was queried for patients with csPCa undergoing RALP (CPT 55866) from 2019-21. Data were merged on patient identifiers with RALP-specific data from 2019-2021. 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, postoperative VTE prophylaxis use, history of prior pelvic surgery, and history of prior radiotherapy. Outcomes included infection, pulmonary embolism (PE), deep venous thrombosis (DVT), acute renal failure, pneumonia, or any surgical complication. RESULTS: 11,811 patients were included in analysis. All records were found to be complete. After RALP, 3.0% of patients had any complications, including 1.8% infections, 0.6% PEs, 0.5% DVT, 0.1% acute renal failures, and 0.3% episodes of pneumonia. There was increased risk of developing complications with older age, higher BMI, longer operative time, absence of perioperative antibiotics, and prior radiotherapy. There was increased risk of infection with history of prior radiotherapy, longer operative time, and higher BMI. Perioperative antibiotic use was found to decrease organ space infections only. Lack of perioperative antibiotic use and higher BMI were associated with PE. Patients with older age were at greater risk for DVT. There was higher risk of acute renal failure with prior radiotherapy. Lack of perioperative antibiotics was associated with pneumonia. CONCLUSIONS: In contemporary NSQIP data, RALP is associated with low complication rates. However, operative time, BMI, age, prior radiotherapy, and perioperative antibiotics are consistent predictors of complications. Attention to these risk factors in peri- and postoperative care are important to minimize risk of postoperative complications and return to a healthcare setting after discharge.
| All Complications | Any Infection | Superficial Infection | Deep Incisional Infection | Organ Space Infection | Plumonary Embolism | DVT | Acute Renal Failure | Pneumonia | |
| ASA Class | |||||||||
| 1 | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
| ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | |
| 2 | 0.8615 | 1.0634 | 0.0748 | 21.3166 | 20.7940 | -0.0955 | 21.0301 | 19.0033 | 18.8429 |
| (-0.54,2.26) | (-0.91,3.04) | (-1.92,2.07) | (-121567.1,121609.74) | (-30059.12,30100.71) | (-2.09,1.9) | (-48814.45,48856.51) | (-79480.9,79518.91) | (-29821.04,29858.73) | |
| 3 | 0.9107 | 1.1046 | -0.0605 | 20.3043 | 20.9674 | -0.0934 | 20.6122 | 20.1474 | 19.5939 |
| (-0.5,2.32) | (-0.88,3.08) | (-2.07,1.95) | (-121568.12,121608.72) | (-30058.95,30100.89) | (-2.1,1.92) | (-48814.87,48856.09) | (-79479.76,79520.05) | (-29820.29,29859.48) | |
| 4 | 1.2061 | 1.3694 | 0.8431 | 0.7499 | 20.5573 | -19.6375 | 21.9919 | -1.0434 | -0.3429 |
| (-0.46,2.87) | (-0.92,3.66) | (-1.59,3.28) | (-202950.24,202951.74) | (-30059.36,30100.48) | (-24312.06,24272.79) | (-48813.49,48857.47) | (-129412.86,129410.78) | (-49664.44,49663.76) | |
| Perioperative Antibiotics | |||||||||
| No | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
| ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | |
| Yes | -0.7586*** | -0.5692* | 0.3427 | -2.0018* | -0.7975** | -0.8511** | -0.7850 | 20.2984 | -1.6347*** |
| (-1.18,-0.34) | (-1.14,0.01) | (-1.07,1.76) | (-4.21,0.21) | (-1.45,-0.14) | (-1.7,-0.0) | (-1.81,0.24) | (-49746.15,49786.74) | (-2.62,-0.65) | |
| Postoperative VTE prophylaxis | |||||||||
| No | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
| ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | |
| Yes | -0.1620 | -0.3213 | -0.5866 | 21.0815 | -0.2116 | -0.1264 | 21.2679 | 19.9231 | -0.9224 |
| (-0.81,0.48) | (-1.09,0.45) | (-1.75,0.58) | (-94170.4,94212.56) | (-1.22,0.8) | (-1.54,1.29) | (-40288.47,40331.0) | (-63427.58,63467.43) | (-2.41,0.56) | |
| Prior Radiotherapy | |||||||||
| No | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
| ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | |
| Yes | 1.2152*** | 1.0548** | 1.1984 | -19.9526 | 0.9627 | 0.7010 | -21.4101 | 2.3496** | 1.2668 |
| (0.51,1.93) | (0.13,1.98) | (-0.25,2.64) | (-173231.91,173192.0) | (-0.22,2.14) | (-1.3,2.7) | (-72397.12,72354.3) | (0.18,4.52) | (-0.78,3.31) | |
| Prior Pelvic Surgery | |||||||||
| No | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
| ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | |
| Yes | 0.1391 | 0.2030 | 0.1894 | -20.7922 | 0.2526 | -0.1492 | 0.0782 | 1.1068 | 0.2445 |
| (-0.13,0.41) | (-0.13,0.54) | (-0.37,0.75) | (-38408.22,38366.64) | (-0.16,0.67) | (-0.8,0.5) | (-0.59,0.74) | (-0.25,2.46) | (-0.62,1.11) | |
| PLND | |||||||||
| No | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference | Reference |
| ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | ~ | |
| Yes | 0.3470* | 0.4271* | 0.3030 | 20.6205 | 0.5072 | -0.1112 | 0.5581 | 0.2453 | 0.3474 |
| (-0.01,0.71) | (-0.04,0.89) | (-0.41,1.02) | (-0.82,0.6) | (-40106.39,40147.63) | (-0.11,1.12) | (-0.36,1.48) | (-2.03,2.52) | (-0.92,1.61) | |
| Number of Nodes Evaluated | -0.0026 | -0.0079 | -0.0287 | 0.0280 | -0.0005 | 0.0114 | -0.0155 | -0.0054 | 0.0134 |
| (-0.02,0.01) | (-0.03,0.01) | (-0.07,0.01) | (-0.04,0.1) | (-0.03,0.02) | (-0.02,0.04) | (-0.06,0.03) | (-0.11,0.09) | (-0.03,0.05) | |
| Age | 0.0202** | 0.0143 | 0.0126 | -0.0820 | 0.0189 | 0.0353* | 0.0694*** | 0.0528 | 0.0303 |
| (0.0,0.04) | (-0.01,0.03) | (-0.02,0.05) | (-0.21,0.05) | (-0.01,0.04) | (-0.0,0.07) | (0.03,0.11) | (-0.05,0.15) | (-0.02,0.09) | |
| Operative Time | 0.1276*** | 0.1892*** | 0.2171*** | 0.3834 | 0.1600** | -0.1425 | 0.1064 | 0.0939 | 0.1682 |
| (0.04,0.21) | (0.09,0.29) | (0.05,0.38) | (-0.11,0.87) | (0.03,0.29) | (-0.36,0.07) | (-0.1,0.32) | (-0.4,0.59) | (-0.08,0.41) | |
| BMI | 0.0361*** | 0.0363*** | 0.0498** | -0.0607 | 0.0309* | 0.0595*** | 0.0508** | 0.0873* | 0.0273 |
| (0.02,0.06) | (0.01,0.06) | (0.01,0.09) | (-0.27,0.14) | (-0.0,0.06) | (0.02,0.1) | (0.0,0.1) | (-0.01,0.19) | (-0.04,0.1) | |
| (-0.01,0.71) | (-0.04,0.89) | (-0.41,1.02) | (-40106.39,40147.63) | (-0.11,1.12) | (-0.82,0.6) | (-0.36,1.48) | (-2.03,2.52) | (-0.92,1.61) |
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