Effect of age and surgical approach on complications and short-term mortality after radical prostatectomy - A population-based study

Objectives. To use population-based data to accurately delineate the types and incidence of complications, risk of readmission, and influence of age a nd surgical approach on short-term mortality after radical prostatectomy. Methods. Medicare claims from 1991 to 1994 were used to identify and quanti fy 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, s urgical approach, and short-term outcomes while adjusting for potential con founders. 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. Th e retropubic approach had a higher risk of respiratory complications (relat ive risk [RR] = 1.53, 95% confidence interval [CI] 1.37 to 1.71)and miscell aneous medical complications (RR = 1.77, 95% CI 1.60 to 1.97) and a lower r isk of miscellaneous surgical complications (RR = 0.86, 95% CI 0.78 to 0.94 ). Differences in medically related gastrointestinal complications partiall y accounted for the differences in miscellaneous medical complications. Rec tal injury with the perineal approach was only similar to 1% to 2%. Readmis sion within 90 days was necessary for 8.5% to 8.7% of patients who underwen t 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 substant ially 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. (C) 1999, Elsevier Science Inc.