Incidence and Risk Factors of Postoperative Complications in Patients Undergoing Robot-assisted Laparoscopic Radical Prostatectomy: A Retrospective Study.

Objective: Robot-assisted laparoscopic radical prostatectomy (RALP) is increasingly used in the treatment of prostate cancer due to its minimally invasive nature, reduced perioperative bleeding, and shorter hospital stays. However, the steep Trendelenburg position and CO₂ pneumoperitoneum required for the procedure present unique anaesthetic challenges, particularly in elderly patients with comorbidities. This study aimed to determine the incidence of anaesthetic complications during RALP and identify independent risk factors associated with these events.

Methods: A retrospective observational study was conducted at Ankara Bilkent City Hospital between 2019 and 2024. A total of 1,020 patients who underwent RALP were evaluated. Collected data included demographic characteristics, the American Society of Anesthesiologists (ASA) physical status classification, comorbidities, and intra- and postoperative outcomes. Anaesthetic complications were analyzed, and multivariate logistic regression was performed to identify independent predictors.

Results: The mean patient age was 65.0±6.3 years, with 65.3% classified as ASA II and 61.6% having at least one comorbidity. Anaesthetic complications occurred in 4.4% of patients. Those with complications were significantly older (67.9±6.2 vs. 64.9±6.3 years, P=0.004), had longer hospital stays (8.98±4.45 vs. 6.83±3.18 days, P < 0.001), and were more frequently admitted to the post-anaesthesia care unit (PACU) (73.3% vs. 46.8%, P < 0.001). Multivariate analysis identified age, hospital stay duration, and PACU admission as independent risk factors.

Conclusion: RALP can be safely performed in experienced centers with individualized anaesthetic management. However, older age, longer hospitalization, and PACU admission significantly increase the risk of anaesthetic complications. These findings emphasize the need for preoperative risk stratification and tailored perioperative care to improve safety outcomes. Prospective, multicenter studies are needed to confirm these results and guide future anaesthetic strategies in robotic urologic surgery.