Factors Associated With Procedure-Specific Complications from RALP/PLND 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: Robotic-assisted laparoscopic prostatectomy (RALP) is a gold standard approach for clinically significant localized prostate cancer (csPCa). The National Surgical Quality Improvement Program (NSQIP) database provides information on RALP outcomes and began including procedure-specific information such as pelvic lymph node dissection (PLND) and postoperative lymphocele and urinary/anastomotic leak in 2019. In this study, we evaluated the association between pre- and perioperative variables on procedure-specific postoperative complications in patients undergoing RALP with PLND. METHODS: NSQIP was queried for patients with csPCa undergoing RALP (CPT 55866) from 2019-21. Data were merged on patient identifiers with the RALP-specific NSQIP data file from those years. Multivariate logistic regression was used to evaluate the association between risk factors and RALP and PLND-specific outcomes. Input variables included ASA class, age, operative time, and BMI. From the extended dataset with PLND information, number of nodes evaluated, perioperative antibiotic use, postoperative VTE prophylaxis use, history of prior pelvic surgery, and history of prior radiotherapy were also included. Outcomes included lymphocele, and urinary/anastomotic leak. RESULTS: 11,811 patients were included in the analysis. All records were found to be complete. After RALP, 2.0% had lymphocele, and 2.5% had urinary/anastomotic leak. Odds of developing lymphocele increased with prior pelvic surgery (OR:1.57, CI:[1.16 - 2.13], p = 0.003), number of nodes evaluated (OR:1.02, CI:[1.01 - 1.03], p = 0.005), and having had PLND (OR:3.05, CI:[1.64 - 5.7], p < 0.001). Perioperative antibiotic use (OR:0.45, CI:[0.29 - 0.71], p = 0.001) was a negative predictor of urinary/anastomotic leaks, but prior radiotherapy (OR:5.52, CI:[2.92 - 10.42], p < 0.001), longer operative time (OR:1.13, CI:[1.04 - 1.24], p = 0.005), BMI (OR:1.04, CI:[1.02 - 1.07], p < 0.001), and prior pelvic surgery (OR:1.4, CI:[1.06 - 1.84], p = 0.017) were positively associated. CONCLUSIONS: History of prior pelvic surgery, PLND, and extent of PLND were found to be associated with lymphocele. urinary/anastomotic leak was associated with prior XRT, pelvic surgery, longer operative time and increased BMI. While risk of these complications is low, they can be highly clinically significant. Attention to risk factors may improve perioperative care and identify patients for efforts at further risk reduction.
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