Abstract
Objectives. To use population-based data to accurately delineate the types and incidence
of complications, risk of readmission, and influence of age and surgical approach
on short-term mortality after radical prostatectomy.
Methods. Medicare claims from 1991 to 1994 were used to identify and quantify the
types and risks of complications, rehospitalization within 90 days, and mortality
at 30 and 90 days after perineal or retropubic prostatectomy. Logistic regression
was used to determine the relationships between age, surgical approach, and short-term
outcomes while adjusting for potential confounders.
Results. On the basis of data from 101,604 men, complications affected 25.0% to 28.8%
of patients treated with the perineal or retropubic approach. The retropubic approach
had a higher risk of respiratory complications (relative risk [RR] = 1.53, 95% confidence
interval [CI] 1.37 to 1.71) and miscellaneous medical complications (RR = 1.77, 95%
CI 1.60 to 1.97) and a lower risk of miscellaneous surgical complications (RR = 0.86,
95% CI 0.78 to 0.94). Differences in medically related gastrointestinal complications
partially accounted for the differences in miscellaneous medical complications. Rectal
injury with the perineal approach was only ∼1% to 2%. Readmission within 90 days was
necessary for 8.5% to 8.7% of patients who underwent the retropubic or perineal approach.
The 30-day mortality was less than 0.5% for men aged 65 to 69; it approached 1% for
men aged 75 and older.
Conclusions. Complications and readmission after prostatectomy are substantially more
common than previously recognized. Notable differences exist in the incidence of respiratory
and nonsurgical gastrointestinal complications, although many short-term outcomes
are comparable for the two approaches. Older age is associated with elevated surgical
mortality and complications.
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Article info
Publication history
Accepted:
February 5,
1999
Received in revised form:
February 5,
1999
Received:
October 26,
1998
Footnotes
☆This project was supported in part by the Health Care Financing Administration, Baltimore, Maryland.
Identification
Copyright
© 1999 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
