LAUSR

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 (ACS-NSQIP) database (2011-2016) was queried for patients who underwent transurethral resection of the prostate (TURP), photoselective vaporization (PVP), or laser enucleation (LEP). 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 peri-operative mortality. Within covariates significant at univariable analyses a stepwise selection, based on AIC values, was performed to fit the most appropriate multivariable model. RESULTS Overall 44939 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 (OR: 2.1, 95% CI: 1.2-3.7, p=0.007), transfusions (OR: 2.5, 95% CI: 1.5-4.1, p<0.001) and pre-operative SIRS or sepsis (OR: 2.6, 95% CI: 1.6-4.2, p<0.001). Similarly, inpatient (OR: 2.0, 95% CI: 1.6-2.5, p<0.001) and non-elective (OR: 1.5, 95% CI: 1.1-2.1, p=0.012) patients experienced higher MACE rates. Peri-operative mortality rates were statistical significantly higher in MACE patients (OR:13.1, 95% CI:8.2-21.0, p<0.001). CONCLUSIONS Up to 1% of patients undergoing TPS experience MACE. MACE are burdened by high mortality rates (up to 14% in MACE patients). Proper patient selection and post-operative monitoring are necessary to reduce MACE incidence and mortality rates.