American Society of Anesthesiologists' (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

Antonio Benito Porcaro; Riccardo Rizzetto; Nelia Amigoni; Alessandro Tafuri; Alberto Bianchi; Sebastian Gallina; Rossella Orlando; Emanuele Serafin; Alessandra Gozzo; Clara Cerrato; Giacomo Di Filippo; Filippo Migliorini; Stefano Zecchini Antoniolli; Giovanni Novella; Vincenzo De Marco; Matteo Brunelli; Maria Angela Cerruto; Enrico Polati; Alessandro Antonelli

doi:10.1007/s13193-022-01577-9

American Society of Anesthesiologists' (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

Indian J Surg Oncol. 2022 Dec;13(4):848-857. doi: 10.1007/s13193-022-01577-9. Epub 2022 Jul 13.

Authors

Antonio Benito Porcaro^#¹, Riccardo Rizzetto^#¹, Nelia Amigoni¹, Alessandro Tafuri¹, Alberto Bianchi¹, Sebastian Gallina¹, Rossella Orlando¹, Emanuele Serafin¹, Alessandra Gozzo¹, Clara Cerrato¹, Giacomo Di Filippo², Filippo Migliorini¹, Stefano Zecchini Antoniolli¹, Giovanni Novella¹, Vincenzo De Marco¹, Matteo Brunelli³, Maria Angela Cerruto¹, Enrico Polati⁴, Alessandro Antonelli¹

Affiliations

¹ Present Address: Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
² Department of General and Hepatobiliary Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
³ Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
⁴ Department of Anesthesiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

^# Contributed equally.

Abstract

Objective: To test the hypothesis of associations of preoperative physical status system with major postoperative complications at hospital discharge in prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP).

Materials and methods: In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. The physical status was assessed by the American Society of Anesthesiologists' (ASA) system, which was computed trained anesthesiologists. The Clavien-Dindo system was used to classify postoperative complications, which were coded as major if greater than 1.

Results: ASA physical status system included class I in 102 patients (8.9%), class II in 934 subjects (81.7%), and class III in 107 cases (9.4%). Clavien-Dindo complications were distributed as follows: grade 1: 141 cases (12.3%), grade 2: 108 patients (9.4%), grade 3a: 5 subjects (0.4%), grade 3b: 9 patients (0.8%), and grade 4a: 3 cases (0.3%). Overall, major complications were detected in 125 cases (10.9%). On multivariate analysis, major Clavien-Dindo complications were predicted by ASA score grade II (adjusted odds ratio, OR = 2.538; 95%CI 1.007-6.397; p = 0.048) and grade III (adjusted OR 3.468; 95%CI 1.215-9.896; p = 0.020) independently by pelvic lymph node dissection (PLND) and/or blood lost.

Conclusion: In RARP surgery, the risk of major postoperative Clavien-Dindo complications increased as the physical status system deteriorated independently by performing or not a PLND and/or large intraoperative blood lost. The ASA score system was an effective predictor of major Clavien-Dindo complications, which delayed LOHS in RARP surgery. Confirmatory studies are required.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-022-01577-9.

Keywords: American Society of Anesthesiologists’ (ASA); Clavien-Dindo grading complications system; Physical status system classification; Postoperative complications; Prostate cancer; Radical prostatectomy; Robot-assisted radical prostatectomy.