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Identifying risk factors for hypoxemia during emergence from anesthesia in patients undergoing robot-assisted laparoscopic radical prostatectomy

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Abstract

Robot-assisted laparoscopic radical prostatectomy (RALP) has emerged as an effective treatment for prostate cancer with obvious advantages. This study aims to identify risk factors related to hypoxemia during the emergence from anesthesia in patients undergoing RALP. A cohort of 316 patients undergoing RALP was divided into two groups: the hypoxemia group (N = 134) and the non-hypoxemia group (N = 182), based on their postoperative oxygen fraction. Comprehensive data were collected from the hospital information system, including preoperative baseline parameters, intraoperative data, and postoperative recovery profiles. Risk factors were examined using multiple logistic regression analysis. The study showed that 38.9% of patients had low preoperative partial pressure of oxygen (PaO2) levels. Several clinical parameters showed significant differences between the hypoxemia group and the non-hypoxemia group, including weight (P < 0.0001), BMI (P < 0.0001), diabetes mellitus (P = 0.044), history of emphysema and pulmonary alveoli (P < 0.0001), low preoperative PaO2 (P < 0.0001), preoperative white blood cell count (P = 0.012), preoperative albumin (P = 0.048), intraoperative bleeding (P = 0.043), intraoperative CO2 accumulation (P = 0.001), duration of surgery (P = 0.046), postoperative hemoglobin level (P = 0.002), postoperative hypoxemia (P = 0.002), and early postoperative fever (P = 0.006). Multiple logistic regression analysis revealed BMI (adjusted odds ratio = 0.696, 95% confidence interval 0.612–0.719), low preoperative PaO2 (adjusted odds ratio = 9.119, 95% confidence interval 4.834–17.203), and history of emphysema and pulmonary alveoli (adjusted odds ratio = 2.804, 95% confidence interval 1.432–5.491) as independent factors significantly associated with hypoxemia on emergence from anesthesia in patients undergoing RALP. Our results demonstrate that BMI, lower preoperative PaO2, and a history of emphysema and pulmonary alveolar disease are independent risk factors associated with hypoxemia on emergence from anesthesia in patients undergoing RALP. These findings provide a theoretical framework for surgeons and anesthesiologists to facilitate strategies to mitigate postoperative hypoxemia in this unique patient population.

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Data availability

The datasets utilized and analyzed in the present study are available from the corresponding author upon reasonable request.

Abbreviations

ALT:

Alanine aminotransferase

ASA:

American Society of Anesthesiology

BGA:

Blood gas analysis

BMI:

Body mass index

CO2 :

Carbon dioxide

Cr:

Creatinine

CRP:

C-reactive protein

DM:

Diabetes mellitus

EtCO2 :

End Tidal Volume of Carbon-dioxide

Hb:

Hemoglobin

ICU:

Intensive care unit

PaCO2 :

Pressure of arterial carbon dioxide

PACU:

Post-anesthesia care unit

PaO2 :

Partial pressure of oxygen

PLT:

Platelet

PPCs:

Postoperative pulmonary complications

RALP:

Robot-assisted laparoscopic radical prostatectomy

WBC:

White blood cell

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Acknowledgements

We would like to express our sincere gratitude to Professor Chonghong Miao from Fudan University, for his invaluable guidance and expertise throughout the course of this research

Funding

The study was funded by Major Scientific Research Projects from Municipal Health Commission of Wuxi (Z202101 X.Z), Guiding Project from Science and Technology Bureau of Wuxi (NZ2021002 X.Z), National Natural Science Foundation of China(82271251 X.Z), Jiangsu Distinguished Medical Expert Project (X.Z) and Jiangsu Health Innovation Team Project (X.Z).

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Authors and Affiliations

  1. Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China

    Qiyao Zhang, Shengjie Yuan, Shunmei Lu & Xin Zhang

  2. Department of Urology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China

    Leilei Zhu

  3. Department of Anesthesiology, Duke University School of Medicine, Durham, NC, 27710, USA

    Xin Zhang

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Contributions

QYZ: Study conception and design, acquisition of data, data analysis and interpretation, manuscript writing and critical revisions. LLZ, JSY and SML: Study conception and design, data analysis and interpretation, manuscript writing and critical revisions. XZ: supervision and critical revisions. All authors read and approved the final manuscript.

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Correspondence to Xin Zhang.

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Ethical approval and consent to participate.

Ethical approval for this study was granted by the Clinical Research Ethics Committee of Wuxi People’s Hospital (Protocol Number: KY23038). The Clinical Research Ethics Committee of Wuxi People’s Hospital waived the need for informed consent.

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Zhang, Q., Zhu, L., Yuan, S. et al. Identifying risk factors for hypoxemia during emergence from anesthesia in patients undergoing robot-assisted laparoscopic radical prostatectomy. J Robotic Surg 18, 200 (2024). https://doi.org/10.1007/s11701-024-01964-0

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