Dillioglugil O, Leibman B D, Leibman N S, Kattan M W, Rosas A L, Scardino P T
Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas, USA.
J Urol. 1997 May;157(5):1760-7.
With recognition of the efficacy of surgical therapy for prostate cancer, there has been a marked increase in the number of radical prostatectomies performed, and substantial changes in surgical technique and perioperative management have decreased the morbidity of this procedure. We assessed the rate of perioperative complications with time and the risk factors for these complications, particularly age, operative time and co-morbidity.
A detailed review of all medical records of a consecutive series of 472 patients treated with radical retropubic prostatectomy by 1 surgeon between 1990 and 1994 was performed to document any complication within 30 days postoperatively. American Society of Anesthesiologists (ASA) physical status classification recorded by the staff anesthesiologist was used as a standard index of co-morbidity.
Major complications were identified in 46 patients (9.8%), minor complications in 101 (21.4%) and none in 341 (72.2%). There were 2 deaths (0.42%). Major complications were not associated with age, operative time or year of operation but were significantly associated with ASA class (p = 0.006) and operative blood loss (p = 0.015) in a logistic regression analysis. Only 16% of patients were assigned to ASA class 3, yet this group included both deaths, a 3-fold increase in major complications, prolonged hospital stay, greater need for intensive care unit admission and more frequent blood transfusions. Major complications were almost 3 times more frequent in class 3 (21.3%) than in class 1 or 2 (7.6%) cases (p <0.005). Minor complications significantly increased hospital stay by a mean of 26% and major complications by 47% (p <0.0001).
Radical retropubic prostatectomy was performed with no perioperative complication in 72% of patients. Major complications resulted in more intensive use of medical resources and were related to co-morbidity rather than age.
随着对前列腺癌手术治疗疗效的认识，根治性前列腺切除术的实施数量显著增加，手术技术和围手术期管理的实质性改变降低了该手术的发病率。我们评估了围手术期并发症发生率随时间的变化以及这些并发症的危险因素，尤其是年龄、手术时间和合并症。
对1990年至1994年间由1名外科医生连续治疗的472例行耻骨后根治性前列腺切除术患者的所有病历进行详细回顾，以记录术后30天内的任何并发症。由麻醉科工作人员记录的美国麻醉医师协会（ASA）身体状况分类用作合并症的标准指标。
46例患者（9.8%）出现主要并发症，101例（21.4%）出现次要并发症，341例（72.2%）无并发症。有2例死亡（0.42%）。在逻辑回归分析中，主要并发症与年龄、手术时间或手术年份无关，但与ASA分级（p = 0.006）和术中失血（p = 0.015）显著相关。仅16%的患者被归为ASA 3级，但该组包括了两例死亡病例，主要并发症增加了3倍，住院时间延长，更需要入住重症监护病房且输血更频繁。3级患者的主要并发症发生率（21.3%）几乎是1级或2级患者（7.6%）的3倍（p <0.005）。次要并发症使住院时间平均显著增加26%，主要并发症使住院时间增加47%（p <0.0001）。
72%的患者行耻骨后根治性前列腺切除术无围手术期并发症。主要并发症导致医疗资源的更多密集使用，且与合并症有关而非年龄。
