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 Australia treated by transurethral resection of the prostate (TURP) or open prostatectomy over a 16-year period.


METHODS
The Western Australian Health Services Research Linked Database was used to extract all hospital morbidity data, death records and 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 repeat prostatectomy, comparing TURP and open prostatectomy, were obtained using Cox regression.


RESULTS
The cases comprised 18 464 TURPs and 1134 open prostatectomies, from 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 absolute risks at 8 years for TURP was 6.6%, and was 3.3% for open prostatectomy.


CONCLUSIONS
The absolute risk of a repeat prostatectomy for TURP and open prostatectomy were consistent with the best reported international experience. There was evidence that the risk in 1990-95 had declined compared with earlier periods, despite a shift towards more closed procedures. The differential risks of repeat prostatectomy should be explained to patients and considered in the development of clinical guidelines, notwithstanding the advantages of TURP over open prostatectomy in terms of surgical morbidity and cost.
Semmens
J B
JB
Centre for Health Services Research, Department of Public Health, The University of Western Australia, Nedlands. james@dph.uwa,edu.au
Wisniewski
Z S
ZS
Bass
A J
AJ
Holman
C D
CD
Rouse
I L
IL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods / Q000639:trends*; D011470:Prostatic Hyperplasia / Q000453:epidemiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000639:trends; D012307:Risk Factors; D020728:Transurethral Resection of Prostate / Q000379:methods / Q000639:trends; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology