MP19-16: Understanding the Risks of Surgery in Urologic Patients with Low Risk Cancers: Quantifying Perioperative Cardiopulmonary Events Following Minimally Invasive Prostatectomy and Partial Nephrectomy

Saturday, September 11, 2021 2:00 PM to 4:00 PM


Authors: Kevin Ginsburg, Alberto Andres Castro Bigalli, Rosalia Viterbo, Richard Greenberg, Robert Uzzo, David Chen, Marc Smaldone, Alexander Kutikov, Andres Correa

Introduction: The choice between active surveillance (AS) and surgical treatment for patients with newly diagnosed low risk malignancies is complex. To inform this nuanced decision, we quantify the incidence of postoperative cardiopulmonary events (CPEs) and the association of CPEs with readmission, reoperation, and length of stay following minimally invasive prostatectomy (MIP) and partial nephrectomy (MIpN).

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients undergoing MIP and MIpN from 2015 to 2019. Cardiopulmonary events included pneumonia, deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, myocardial infarction (MI), cardiovascular arrest, and death. Proportions were compared with the Chi-squared test and continuous measures compared with the Wilcoxon rank-sum test. To test for an association of CPEs with readmission, reoperation, and length of stay, we fit multivariable logistic and negative binomial regression models adjusting for clinical and demographic factors.

Results: A total of 64,975 patients undergoing MIP (46,869) and MIpN (18,106) met inclusion criteria, of which 1,160 patients (1.8%) had a cardiopulmonary event and included 87 deaths. Within 30 days of the index surgery, 2,876 patients (4.4%) were readmitted and 872 (1.3%) underwent reoperation. Patients with postoperative CPEs harbored a significantly higher risk of readmission (44.7% vs. 3.7%, p<0.001), reoperation (10.3% vs. 1.2%, p<0.001), and longer postoperative length of stay (2 days vs. 1 day, p<0.001) compared with patients without CPEs. After adjustment, perioperative cardiopulmonary events were associated with readmission (OR 20.1, 95% CI 17.7-22.8, p<0.001), reoperation (OR 8.94, 95% CI 7.25-11.0, p<0.001), and length of stay (IRR 2.37, 95% CI 2.21-2.55, p<0.001) in the multivariable models.

Conclusions: Risks of serious cardiopulmonary postoperative events after MIP and MIpN are rare, but similar to risks of a cancer-specific mortality for patients with low risk prostate and renal cancer. Yet, such perioperative risks are immediate, while oncologic risks are delayed. This information should be integrated into the shared decision-making process in patients with neoplasms for which active surveillance has been established as an oncologically safe option.

Source of Funding: None
Therapeutic Area
Health PolicyPractice Management