Ayoub Christian Habib, Chalhoub Viviane, El-Achkar Adnan, Abou Heidar Nassib, Tamim Hani, Maroun-Aouad Marie, El Hajj Albert
Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Anesthesia and Intensive Care, Hotel-Dieu de France Hospital, Saint-Joseph University Medical School, Beirut, Lebanon.
Ther Adv Urol. 2023 Jan 19;15:17562872221150217. doi: 10.1177/17562872221150217. eCollection 2023 Jan-Dec.
Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients.
The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score-matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis.
A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP ( < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP ( = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP ( = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP.
MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques.
与全身麻醉（genTURP）或脊髓麻醉（spTURP）下的经尿道前列腺切除术（TURP）相比，监护麻醉/镇静下的经尿道前列腺切除术（macTURP）是一种更安全且较少使用的技术，适用于高危患者。
本研究旨在比较三种麻醉技术下TURP术后30天的结果。
查询美国外科医师学会国家外科质量改进计划数据库中2008年至2019年间接受TURP的患者。比较人口统计学、实验室值、病史和30天的结果。构建术后并发症的单变量和多变量回归模型。然后对genTURP和macTURP以及spTURP和macTURP进行倾向评分匹配分析作为敏感性分析。
共有53182例患者接受了TURP。与genTURP相比，年龄较大（>80岁）、需要胰岛素治疗的糖尿病患者（7.9%）、白细胞增多症患者（7.4%）、慢性阻塞性肺疾病（COPD）病史患者（7.8%）、呼吸困难患者（7.2%）以及美国麻醉医师协会分级>2级的患者（58.8%）更有可能接受macTURP（<0.013）。与genTURP相比，spTURP的尿路感染（UTI）发生率较低[比值比（OR）=0.869]（=0.049），而与genTURP相比，macTURP的主要不良心血管事件发生率较高（OR=2.179）（=0.005）。所有其他术后并发症在三种手术之间的发生率相似。倾向评分匹配队列表明，macTURP与genTURP之间以及macTURP与spTURP之间在术后并发症发生率上没有差异。
与genTURP和spTURP相比，发现macTURP是可行的，且安全性良好。与更具侵入性的麻醉技术相比，macTURP可用于老年、体弱和合并症患者，且安全性相似。
