30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity (original) (raw)

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

Correspondence to: Shabbir M. H. Alibhai, MD, MSc, University Health Network, Room EN 14-214, 200 Elizabeth Street, Toronto. M5G 2C4, Canada (e-mail: shabbir.alibhai@uhn.on.ca ).

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

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Affiliations of authors: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada (SMHA, ML, GT, MDK, GN); Geriatric Program, Toronto Rehabilitation Institute, Canada (SMHA, GN); Departments of Medicine (SMHA, MDK, GN), Health Policy, Management and Evaluation (SMHA, MDK, GN), Public Health Sciences (GT), and Surgery (NF), University of Toronto, Canada; Division of Preventive Oncology, Cancer Care Ontario, Toronto, Canada (EH)

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Revision received:

29 July 2005

Accepted:

09 September 2005

Published:

19 October 2005

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Shabbir M. H. Alibhai, Marc Leach, George Tomlinson, Murray D. Krahn, Neil Fleshner, Eric Holowaty, Gary Naglie, 30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity, JNCI: Journal of the National Cancer Institute, Volume 97, Issue 20, 19 October 2005, Pages 1525–1532, https://doi.org/10.1093/jnci/dji313
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Abstract

Background: Radical prostatectomy is associated with excellent long-term disease control for localized prostate cancer. Prior studies have suggested an increased risk of short-term complications among older men who underwent radical prostatectomy, but these studies did not adjust for comorbidity. Methods: We examined mortality and complications occurring within 30 days following radical prostatectomy among all 11 010 men who underwent this surgery in Ontario, Canada, between 1990 and 1999 using multivariable logistic regression modeling. We adjusted for comorbidity using two common comorbidity indices. Statistical tests were two-sided. Results: Overall, 53 men (0.5%) died, and 2246 (20.4%) had one or more complications within 30 days of radical prostatectomy. In models adjusted for comorbidity and year of surgery, age was associated with an increased risk of 30-day mortality (odds ratio = 2.04 per decade of age, 95% confidence interval [CI] = 1.23 to 3.39). However, the absolute 30-day mortality risk was low, even in older men, at 0.66% (95% CI = 0.2 to 1.1%) for men aged 70–79 years. In adjusted models, age was associated with an increased risk of cardiac ( _P_trend <.001), respiratory ( _P_trend = .01), and miscellaneous medical ( _P_trend = .058) complications. Similarly, increasing comorbidity was associated with a higher risk of all categories of complications. Conclusions: Increasing comorbidity is a stronger predictor than age of almost all categories of early complications after radical prostatectomy. The risk of postoperative mortality after radical prostatectomy is relatively low for otherwise healthy older men up to age 79.

© The Author 2005. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org.

Topic:

• canada
• comorbidity
• surgical procedures, operative
• heart
• mortality
• radical prostatectomy
• older adult
• ontario

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