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Matthias Orberger, Rein-Jüri Palisaar, Florian Bernhard Gerhard Roghmann, Ludger Mittelstädt, Petra Bischoff, Joachim Noldus, Björn Löppenberg

• \(\textit {Objective:}\) To evaluate whether the Surgical Apgar Score (SAS) can identify patients who are at risk for perioperative adverse events (PAE) following radical prostatectomy for prostate cancer. \(\textit {Patients and Methods:}\) At a single academic institution, 994 patients undergoing radical prostatectomy between 2010 and 2013 were analyzed retrospectively. The SAS was calculated from anesthesia records, evaluated to predict PAE within a 30-day time period postoperatively; these events were classified according to standardized classification systems. \(\textit {Results:}\) We observed adverse events in 45.4% (451/994) of patients with a total of 694 events. Overall, 41% (408/994) had low- and 9.9% (98/994) had highgrade events. A lower SAS was identified as an independent predictor of any (p < 0.001) and low-grade adverse events (p = 0.001) for those patients who had undergone open retropubic radical prostatectomy (ORRP). Each 1-point increment resulted in a 24% decrease in the odds of any (95% CI 0.66–0.88) and a 21% decrease in the odds of a low-grade (95% CI 0.69–0.91) event. Adverse events of robot-assisted prostatectomy were not associated with the SAS. \(\textit {Conclusions:}\) Lower SAS values indicate patients at risk for adverse events after ORRP. The SAS might serve as one variable for outcome assessment, reflecting the challenge of mutual surgical and anesthesiology procedure management.