Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate

BACKGROUND: 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. OBJECTIVES: The aim of this stud...

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Detalles Bibliográficos
Autores principales: Ayoub, Christian Habib, Chalhoub, Viviane, El-Achkar, Adnan, Abou Heidar, Nassib, Tamim, Hani, Maroun-Aouad, Marie, El Hajj, Albert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Original Research
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9869224/
https://www.ncbi.nlm.nih.gov/pubmed/36699641
http://dx.doi.org/10.1177/17562872221150217
Descripción
Sumario:BACKGROUND: 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. OBJECTIVES: The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques. DESIGN AND METHODS: 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. RESULTS: 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 (p < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP (p = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP (p = 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. CONCLUSION: 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.

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