Key result
ASA 3-4 classification was not associated with a statistically significant increase in major perioperative complications compared to ASA 1-2 classification in patients undergoing uro-oncological surgeries.
Why the study?
The study was conducted to compare perioperative adverse effects and evaluate the impact of ASA classification on surgical outcomes in patients classified as ASA 1-2 versus ASA 3-4 undergoing major oncological urological surgeries.
Does ASA 3-4 classification increase perioperative grade 4-5 complications compared to ASA 1-2 in patients undergoing major uro-oncological surgeries?
Cohort (n=367)
No
Does ASA 3-4 classification increase perioperative grade 4-5 complications compared to ASA 1-2 in patients undergoing major uro-oncological surgeries?
Optimized perioperative management and advanced surgical techniques may mitigate the expected higher complication rates in ASA 3-4 patients undergoing uro-oncological surgeries.
Objective: This study aims to compare perioperative adverse effects between patients classified as American Society of Anesthesiologists (ASA) 1-2 and ASA 3-4 undergoing major oncological urological surgeries.It also evaluates the impact of ASA classification on surgical outcomes.Materials and Methods: A retrospective analysis was conducted on patients who underwent open, laparoscopic, or robotic surgery for bladder, kidney, ureter, and prostate cancer between 2022 and 2024.Patients were categorized into two groups: ASA 1-2 (group 1) and ASA 3-4 (group 2).Perioperative complications were classified using the Clavien-Dindo grading system, focusing on grade 4-5 complications.Statistical analyses were performed using chi-square and Mann-Whitney U tests, with p<0.05 considered statistically significant.Results: A total of 367 patients were included in the study: 198 radical prostatectomy cases, 76 nephrectomy cases, 41 partial nephrectomy cases, 30 cystectomy cases, and 22 nephroureterectomy cases.Of these, 198 patients were classified as ASA 1-2, while 169 were ASA 3-4.Grade 4-5 complications included pulmonary embolism, sepsis, myocardial infarction, atrial fibrillation, disseminated intravascular coagulation, and death.However, there was no statistically significant difference in the incidence of major complications between ASA groups across different surgical procedures (p>0.05).Conclusion: Despite the expectation of higher complication rates in ASA 3-4 patients, no significant difference was observed between ASA-groups in perioperative adverse effects.This finding suggests that optimized perioperative management and advanced surgical techniques may mitigate the impact of ASA classification on surgical outcomes in oncological urology.
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Sancı et al. (2025) conducted a cohort in Uro-oncological malignancies (n=367). ASA 3-4 classification vs. ASA 1-2 classification was evaluated on Grade 4-5 perioperative complications (Clavien-Dindo) (p=>0.05). ASA 3-4 classification was not associated with a statistically significant increase in major perioperative complications compared to ASA 1-2 classification in patients undergoing uro-oncological surgeries.
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