Presentation Authors: Kevin Ginsburg*, John Cochrane, Rohith Arcot, Detroit, MI, Scott Eggener, Chicago, IL, Michael Cher, Detroit, MI
Introduction: Perioperative cardiovascular (CV) events following radical prostatectomy are relatively rare. As a result, the incidence, risk factors, and impact of cardiovascular events following radical prostatectomy are not well characterized.
Methods: We used the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database to estimate the incidence of CV events in patients undergoing radical prostatectomy with and without pelvic lymphadenectomy. Univariable analysis was used to compare parameters associated with the outcomes of interest (CV events, readmission, and death). Variables that were significant (p < 0.05) or neared significance (p < 0.1) were entered into multivariable backwards stepwise logistic regression models.
Results: From 2008-2016, we identified 47,571 patients who underwent perineal, retropubic, and laparoscopic/robotic prostatectomy. We identified 1,140 CV complications in 971 patients (2.0%, 95% CI 1.9%-2.2%) consisting of 486 DVTs, 346 PEs, 152 MIs, 90 cardiac arrests, and 66 CVAs. Factors associated with CV events are shown in Table 1. In our MV model, CV events were associated with metastatic cancer (OR 1.59, 95% CI 1.03-2.46), BMI 30-39.9 (OR 1.34, 95% CI 1.01-1.77), BMI >=40 (OR 2.34, 95% CI 1.49-3.68), elevated serum creatinine (>1.5mg/dL, OR 1.40, 95% CI 1.05-1.87), low serum albumin ( < 3.5mg/dL, OR 1.57, 95% CI 1.15-2.13), increase in age per year (OR 1.04, 95% CI 1.028-1.052) and increase in OR time per minute (OR 1.004, 95% CI 1.003-1.004) In contrast, laparoscopic/robotic surgery was protective (OR 0.568, 95% CI 0.47-0.69). CV events were strongly associated with both readmission (OR 8.44, 95% CI 6.61-10.8, p < 0.001) and death (OR 33.0, 95% CI 19.6-55.3, p < 0.001).
Conclusions: Perioperative CV events are relatively rare (2%) following radical prostatectomy. Several factors including increased BMI, elevated serum creatinine, and low serum albumin were associated with CV events while patients undergoing laparoscopic/robotic prostatectomy was protective. These data may prove beneficial for patients and their providers considering radical prostatectomy.