title: 30-day mortality and major complications after radical prostatectomy: influence of age and comorbidity.
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 2195 [corrected] (19.9%[corrected]) 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 (Ptrend < .001), respiratory (Ptrend = .01), and miscellaneous medical (Ptrend = .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.
authors.affiliation: Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada. shabbir.alibhai@uhn.on.ca
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: Marc
authors.initials: M
authors.lastname: Leach
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
authors.forename: Eric
authors.initials: E
authors.lastname: Holowaty
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors