Abstract:Objective To collect perioperative data of patients undergoing robot-assisted radical prostatectomy (RARP) and explore the related factors of postoperative hypoxemia in Anesthesia Intensive Care Unit (AICU). Methods Clinical data of patients who underwent RARP and were admitted to the AICU at Nanjing Drum Tower Hospital between January 2022 and May 2024 were retrospectively collected. According to the oxygenation index (OI) from the last arterial blood gas analysis before transfer out of the AICU, patients were divided into a hypoxemia group (OI<300 mmHg) and a non- hypoxemia group (OI≥300 mmHg). Clinical data of the two groups, including general information, laboratory results, surgery-related indicators, intraoperative medication use, and indicators after AICU admission, were collected and compared. Multivariate logistic regression analysis was used to identify risk factors for hypoxemia before transfer out of hypoxemia before transfer out of the AICU in RARP patients. Results A total of 1 002 patients were included in the analysis, of whom 256 developed hypoxemia before transfer out of the AICU, with an incidence rate of 25.55%. There were significant differences between the two groups in age, body mass index (BMI), hypertension, history of pulmonary disease, white blood cell count, and blood glucose (P<0.05). Significant differences were also found in preoperative saturation of peripheral oxygen (SpO₂), operation duration, anesthesia duration, total colloid volume, morphine equivalent, and glucocorticoid use (P<0.05). And there were significant differences in the OI upon AICU admission, pH, PaCO₂, C-reactive protein, high- sensitivity troponin T, and total AICU output (P<0.05). Multivariate analysis revealed that age ≥65 years (OR=1.551, 95%CI: 1.003-2.396, P=0.048), BMI>28 kg/m² (OR=1.739, 95%CI: 1.033-2.928, P=0.037), hypertension (OR=1.586, 95%CI: 1.143-2.202, P=0.006), history of pulmonary disease (OR=1.600, 95%CI: 1.159-2.208, P=0.004), preoperative SpO₂<95% (OR=2.807, 95%CI: 1.297-6.077, P=0.009), low OI upon AICU admission (OR=3.620, 95%CI: 2.553- 5.131, P<0.01), and delayed postoperative extubation time (OR=1.002, 95%CI: 1.000-1.003, P=0.013) were risk factors for hypoxemia in RARP patients in the AICU, while intraoperative glucocorticoid use (OR=0.613, 95%CI: 0.445-0.845, P=0.003) was a protective factor. Conclusion Age, BMI, hypertension, history of pulmonary disease, preoperative SpO₂, OI upon AICU admission, postoperative extubation time, and intraoperative glucocorticoid use are closely associated with the occurrence of hypoxemia in RARP patients at AICU.