AN ASSESSMENT OF RADICAL PROSTATECTOMY - TIME TRENDS, GEOGRAPHIC-VARIATION, AND OUTCOMES

Objectives.-To examine temporal trends and geographic variation in rad ical prostatectomy rates and short-term outcomes. Design.-Population-b ased study of radical prostatectomy for the years 1984 through 1990. P oisson regression was used to estimate temporal and regional effects. Setting.-The 50 states and the District of Columbia. Participants.-A 2 0% national sample of male Medicare beneficiaries aged 65 years or old er. Main Outcome Measures.-Rate of radical prostatectomy; 30-day morta lity; and major cardiopulmonary complications, vascular complications, or surgical repairs within 30 days of radical prostatectomy. Results. -A total of 10 598 radical prostatectomies were identified. The adjust ed rate of radical prostatectomy in 1990 was 5.75 times that in 1984. The relative increase was similar in all age groups. Substantial geogr aphic variation existed in rates from 1988 through 1990: all states in the New England and Mid-Atlantic regions had rates equal to or below 60 per 100 000 male Medicare beneficiaries, while all states in the Pa cific and Mountain regions had rates equal to or above 130 per 100 000 . The mortality and morbidity after radical prostatectomy are not triv ial for older men (aged 75 years and older)-almost 2% died and nearly 8% suffered major cardiopulmonary complications within 30 days of the operation. Conclusion.-The sharp increase and wide geographic variatio n in radical prostatectomy rates make the evaluation of this surgical procedure a pressing issue. The rising rate of radical prostatectomy a mong men aged 75 years and older merits special attention.