title: Effect of age and surgical approach on complications and short-term mortality after radical prostatectomy--a population-based study.
abstract: OBJECTIVE
  To use population-based data to accurately delineate the types and incidence of complications, risk of readmission, and influence of age and surgical approach on short-term mortality after radical prostatectomy.
  
  
  METHODS
  Medicare claims from 1991 to 1994 were used to identify and quantify 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, surgical approach, and short-term outcomes while adjusting for potential confounders.
  
  
  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. The retropubic approach had a higher risk of respiratory complications (relative risk [RR] = 1.53, 95% confidence interval [CI] 1.37 to 1.71) and miscellaneous medical complications (RR = 1.77, 95% CI 1.60 to 1.97) and a lower risk of miscellaneous surgical complications (RR = 0.86, 95% CI 0.78 to 0.94). Differences in medically related gastrointestinal complications partially accounted for the differences in miscellaneous medical complications. Rectal injury with the perineal approach was only approximately 1% to 2%. Readmission within 90 days was necessary for 8.5% to 8.7% of patients who underwent 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 substantially 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.
authors.affiliation: HealthStat, Princeton, New Jersey, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Lu-Yao
authors.forename: P
authors.initials: P
authors.lastname: Albertsen
authors.forename: J
authors.initials: J
authors.lastname: Warren
authors.forename: S L
authors.initials: SL
authors.lastname: Yao
mesh_terms: D000367:Age Factors; D000368:Aged; D006801:Humans; D015994:Incidence; D008297:Male; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012306:Risk; D012307:Risk Factors; D013997:Time Factors