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

Christian Habib Ayoub; Viviane Chalhoub; Adnan El-Achkar; Nassib Abou Heidar; Hani Tamim; Marie Maroun-Aouad; Albert El Hajj

doi:10.1177/17562872221150217

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

Ther Adv Urol. 2023 Jan 19:15:17562872221150217. doi: 10.1177/17562872221150217. eCollection 2023 Jan-Dec.

Authors

Christian Habib Ayoub¹, Viviane Chalhoub², Adnan El-Achkar¹, Nassib Abou Heidar¹, Hani Tamim^{3

4}, Marie Maroun-Aouad⁵, Albert El Hajj⁶

Affiliations

¹ Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
² Department of Anesthesia and Intensive Care, Hotel-Dieu de France Hospital, Saint-Joseph University Medical School, Beirut, Lebanon.
³ Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
⁴ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
⁵ Department of Anesthesiology, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon.
⁶ Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon.

Abstract

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.

Keywords: anesthesia; benign prostatic hyperplasia; endourology; prostate.