INTRODUCTION AND OBJECTIVE:
To investigate on associations of the American Society of Anesthesiologists’ (ASA) physical status system with features related to clinical prostate cancer (PCa patients) treated with radical prostatectomy (RP) in a large and contemporary cohort operated in a tertiary referral center.
In a period ranging from January 2013 to October 2020, 1329 patients were evaluated. The ASA system was computed by anesthesiologists dedicated to urological procedures. Evaluated features were grouped into preoperative, pathological and perioperative parameters, which were associated with the ASA system by statistical methods.
Overall, the surgical approach was robot assisted (RARP) in 86% of patients and PLND was performed in 65.1% of cases. Any postoperative Clavien-Dindo complication at discharge occurred in 27.2% of cases. The distribution of the ASA physical status system was as follows: ASA I in 108 patients (8.1%), ASA II in 1081 subjects (81.3%) and ASA III in 140 cases (10.5%). Median LOHS was the same for ASA groups I and II (4 days), but longer (5 days) for the ASA group III. There were significant associations of the ASA grading system with physical and perioperative features. As the physical state deteriorated, age, body mass index (BMI), intraoperative blood lost, postoperative Clavien-Dindo complications and length of hospital stay (LOHS). On multivariate Cox proportional hazards, the risk of being free of any postoperative complication at hospital discharge decreased as the ASA physical system deteriorated, as open RP (ORP) was performed as well as intraoperative blood lost increased; furthermore, the strength of associations were stronger for ASA III (hazard ratio, HR=1,659; 95%CI: 1,181 – 2,332; p=0.004) than for ORP and blood lost.
In large contemporary cohort patients undergoing PCa surgery, ASA system associated with any Clavien-Dindo complication at hospital discharge as well as with LOHS. As the physical system of patients deteriorated, the risk of being free from any postoperative complication decreased and LOHS delayed, as well. Although PCa surgery is a hazard in ASA III subgroup, RP can be safely delivered in tertiary referral centers. ASA physical status grading system, together with age and life expectancy, is an important parameter for counselling PCa patients.
Source of Funding: