Early postoperative complications significantly influence short-term recovery after radical prostatectomy. Although laparoscopic radical prostatectomy (LRP) provides perioperative advantages compared with open radical prostatectomy (ORP), its impact on early morbidity remains uncertain. This study aimed to compare 30-day postoperative complications between ORP and LRP and to identify independent predictors of early morbidity. This retrospective two-center cohort included 149 consecutive patients undergoing ORP (n = 98) or LRP (n = 51) between 2022 and 2024. Complications were graded using the Clavien–Dindo classification. Multivariable logistic regression models evaluated independent predictors, including age, body mass index (BMI), pelvic lymph node dissection (PLND), and surgical approach. LRP was associated with shorter operative time (193.1 ± 18.9 vs 231.0 ± 27.0 minutes; P < 0.001), lower estimated blood loss (396.1 ± 114.4 vs 534.7 ± 108.3 mL; P < 0.001), and shorter hospitalization (4.92 ± 1.07 vs 6.50 ± 1.12 days; P < 0.001). Early complications occurred in 18.1% of patients (21.4% ORP vs 11.8% LRP; absolute difference 9.6%; 95% CI, –2.4% to 21.6%; P = 0.146). The distribution of complication severity was similar between groups. In multivariable analysis, BMI independently predicted early complications (OR = 1.76 per kg/m2; P < 0.001), and PLND was associated with increased risk in the extended model (OR = 5.51; P = 0.009). The surgical approach was not independently associated with complications. Despite clear perioperative advantages of LRP, early postoperative morbidity appeared more strongly associated with BMI and PLND than with surgical access. Larger prospective studies are warranted.
