Michele Marchioni1, Luca Cindolo2, Marta Di Nicola3, Luigi Schips4, Marco De Sio5, Estevão Lima6, Vincenzo Mirone7, Luigi Cormio8, Evangelos Liatsikos9, Francesco Porpiglia10, Riccardo Autorino11. 1. Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Laboratory of Biostatistics, Chieti, Italy; Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, "SS. Annunziata" Hospital, Chieti, Italy. Electronic address: mic.marchioni@gmail.com. 2. Department of Urology, ASL Abruzzo 2, Chieti, Italy. 3. Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Laboratory of Biostatistics, Chieti, Italy. 4. Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, "SS. Annunziata" Hospital, Chieti, Italy. 5. Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy. 6. Department of Urology, Hospital of Braga, Braga, Portugal. 7. Department of Urology, Federico II University, Naples, Italy. 8. Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy. 9. Department of Urology, University of Patras, Patras, Greece. 10. Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Italy. 11. Department of Surgery, Division of Urology, VCU Health, Richmond, VA.
Abstract
OBJECTIVE: To test the prevalence and predictors of major acute cardiovascular events (MACE) after transurethral prostate surgery (TPS). MATERIAL AND METHODS: The American College of Surgeons National Surgical Quality Improvement Program database (2011-2016) was queried for patients who underwent transurethral resection of the prostate, photoselective vaporization, or laser enucleation. MACE included: cerebrovascular events, cardiac arrest, myocardial infarction, deep venous thrombosis requiring therapy, and pulmonary embolism episodes occurred up to 30 days after discharge. Univariable and multivariable logistic regression models tested MACE predictors and effect of MACE on perioperative mortality. Within covariates significant at univariable analyses a stepwise selection, based on Akaike Information Criterion values, was performed to fit the most appropriate multivariable model. RESULTS: Overall 44,939 patients were included in our analyses. Of these 365 (0.8%) had MACE within 30 days after surgery. The strongest MACE predictors were recent congestive heart failure (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.2-3.7, P = .007), transfusions (OR: 2.5, 95% CI: 1.5-4.1, P <.001) and preoperative Systemic Inflammatory Response Syndrome or sepsis (OR: 2.6, 95% CI: 1.6-4.2, P <.001). Similarly, inpatient (OR: 2.0, 95% CI: 1.6-2.5, P <.001) and nonelective (OR: 1.5, 95% CI: 1.1-2.1, P = .012) patients experienced higher MACE rates. Perioperative mortality rates were statistical significantly higher in MACE patients (OR: 13.1, 95% CI: 8.2-21.0, P <.001). CONCLUSION: Up to 1% of patients undergoing transurethral prostate surgery experience MACE. MACE are burdened by high mortality rates (up to 14% in MACE patients). Proper patient selection and postoperative monitoring are necessary to reduce MACE incidence and mortality rates.
OBJECTIVE: To test the prevalence and predictors of major acute cardiovascular events (MACE) after transurethral prostate surgery (TPS). MATERIAL AND METHODS: The American College of Surgeons National Surgical Quality Improvement Program database (2011-2016) was queried for patients who underwent transurethral resection of the prostate, photoselective vaporization, or laser enucleation. MACE included: cerebrovascular events, cardiac arrest, myocardial infarction, deep venous thrombosis requiring therapy, and pulmonary embolism episodes occurred up to 30 days after discharge. Univariable and multivariable logistic regression models tested MACE predictors and effect of MACE on perioperative mortality. Within covariates significant at univariable analyses a stepwise selection, based on Akaike Information Criterion values, was performed to fit the most appropriate multivariable model. RESULTS: Overall 44,939 patients were included in our analyses. Of these 365 (0.8%) had MACE within 30 days after surgery. The strongest MACE predictors were recent congestive heart failure (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.2-3.7, P = .007), transfusions (OR: 2.5, 95% CI: 1.5-4.1, P <.001) and preoperative Systemic Inflammatory Response Syndrome or sepsis (OR: 2.6, 95% CI: 1.6-4.2, P <.001). Similarly, inpatient (OR: 2.0, 95% CI: 1.6-2.5, P <.001) and nonelective (OR: 1.5, 95% CI: 1.1-2.1, P = .012) patients experienced higher MACE rates. Perioperative mortality rates were statistical significantly higher in MACE patients (OR: 13.1, 95% CI: 8.2-21.0, P <.001). CONCLUSION: Up to 1% of patients undergoing transurethral prostate surgery experience MACE. MACE are burdened by high mortality rates (up to 14% in MACE patients). Proper patient selection and postoperative monitoring are necessary to reduce MACE incidence and mortality rates.
Authors: David-Dan Nguyen; Claudia Deyirmendjian; Kyle Law; Naeem Bhojani; Dean S Elterman; Bilal Chughtai; Franck Bruyère; Luca Cindolo; Giovanni Ferrari; Carlos Vasquez-Lastra; Tiago Borelli-Bovo; Edgardo F Becher; Hannes Cash; Maximillian Reimann; Enrique Rijo; Vincent Misrai; Kevin C Zorn Journal: World J Urol Date: 2022-03-26 Impact factor: 4.226