Complications after radical retropubic prostatectomy in the Medicare population

Objectives. Radical prostatectomy is the standard of care for the treatment of clinically localized prostate cancer in the appropriate patient. Howeve r, the morbidity associated with this procedure remains controversial, sinc e complications from centers of excellence are low but nationwide surveys h ave reported a much higher risk of complications. This study reports the co mplication rates after radical retropubic prostatectomy (RRP) for men in th e Medicare population. Methods. All men in the Medicare population who underwent RRP in 1991 were identified. All inpatient, outpatient, and physician (Part B) Medicare clai ms for these men for 1991 to 1993 were then analyzed to determine outcomes. Procedures performed for complications resulting from RRP were recorded, a s were the diagnosis codes that may have heralded a complication after RRP. Results. In 1991, 25,651 men in the Medicare population underwent RRP. The mean age of these men was 70.5 years. Procedures for the relief of bladder outlet obstruction or urethral strictures after RRP occurred in 19.5% of th ese men. A penile prosthesis was implanted in 718 men (2.8%) after prostate ctomy, and 593 men (2.3%) had an artificial urinary sphincter placed after prostatectomy. A diagnosis of urinary incontinence was reported in 5573 men (21.7%) after radical prostatectomy, but only 2025 of these men (7.9%) con tinued to carry this diagnosis more than 1 year after prostatectomy. A diag nosis of erectile dysfunction was reported in 5510 men (21.5%) after radica l prostatectomy, but only 3276 of these men (12.8%) continued to carry this diagnosis more than 1 year after surgery. Conclusions. A review of a large, nationwide, heterogenous cohort of men re vealed a morbidity rate that is slightly higher than that reported by major centers that perform large numbers of radical retropubic prostatectomies b ut is lower than complication rates obtained by patient surveys. The limita tions of claim information in determining patient outcomes, however, must b e considered when evaluating these data. UROLOGY 56: 116-120, 2000. (C) 200 0, Elsevier Science Inc.