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

Abstract

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-16 UNDERSTANDING THE RISKS OF SURGERY IN UROLOGIC PATIENTS WITH LOW RISK CANCERS: QUANTIFYING PERIOPERATIVE CARDIOPULMONARY EVENTS FOLLOWING MINIMALLY INVASIVE PROSTATECTOMY AND PARTIAL NEPHRECTOMY Kevin Ginsburg, Alberto Andres Castro Bigalli, Rosalia Viterbo, Richard Greenberg, Robert Uzzo, David Chen, Marc Smaldone, Alexander Kutikov, and Andres Correa Kevin GinsburgKevin Ginsburg More articles by this author , Alberto Andres Castro BigalliAlberto Andres Castro Bigalli More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Robert UzzoRobert Uzzo More articles by this author , David ChenDavid Chen More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Andres CorreaAndres Correa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e334-e334 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Ginsburg More articles by this author Alberto Andres Castro Bigalli More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author Robert Uzzo More articles by this author David Chen More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Andres Correa More articles by this author Expand All Advertisement Loading ...