Trends in repeat prostatectomy after surgery for benign prostate disease: application of record linkage to healthcare outcomes

Objective To compare the risk of repeat prostatectomy for benign prostatic hyperplasia (BPH) in a population-based cohort of 19 598 men in Western Aus tralia treated by transurethral resection of the prostate (TURP) or open pr ostatectomy over a 16-year period. Patients and methods The Western Australian Health Services Research Linked Database was used to extract all hospital morbidity data, death records an d prostate cancer registrations for men who had prostate surgery for BPH in 1980-95. The cumulative incidence of first repeat prostatectomy calculated using the actuarial life-table and incidence-rate ratios of the first repe at prostatectomy, comparing TURP and open prostatectomy, were obtained usin g Cox regression. Results The cases comprised 18 464 TURPs and 1134 open prostatectomies, fro m which there were 1095 subsequent repeat prostatectomies. After adjustment for calendar time, age and admission type, the incidence rate of the first repeat prostatectomy was up to 2.30 times higher (95% confidence interval, 1.62-3.27) after initial TURP than for initial open prostatectomy. The abs olute risks at 8 years for TURP was 6.6%, and was 3.3% for open prostatecto my. Conclusion The absolute risk of a repeat prostatectomy for TURP and open pr ostatectomy were consistent with the best reported international experience . There was evidence that the risk in 1990-95 had declined compared with ea rlier periods, despite a shift towards more closed procedures. The differen tial risks of repeat prostatectomy should be explained to patients and cons idered in the development of clinical guidelines, notwithstanding the advan tages of TURP over open prostatectomy in terms of surgical morbidity and co st.