title: Open radical prostatectomy in the elderly: a case for concern?
abstract: Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Adverse outcomes after radical prostatectomy are more often recorded in the elderly. In the USA, elderly patients undergoing radical prostatectomy are treated at institutions where suboptimal outcomes are recorded.
  
  
  OBJECTIVE
  • To assess the rate of adverse outcomes after open radical prostatectomy (ORP) in the elderly and to examine the effect of annual hospital caseload (AHC) and academic institutional status on adverse outcomes in these of patients.
  
  
  METHODS
  • Within the Health Care Utilization Project Nationwide Inpatient Sample, we focused on ORPs performed between 1998 and 2007. Subsequently, we restricted to patients aged ≥75 years. • In both datasets, we examined transfusion rates, intra-operative and postoperative complication rates, and in-hospital mortality rates. • Stratification was performed according to AHC tertiles and academic status. • Multivariable logistic regression analyses were fitted.
  
  
  RESULTS
  • Of 115,554 ORP patients, 2109 (1.8%) were aged ≥75 years. • In multivariable analyses performed in the entire cohort, elderly age increased homologous blood transfusion rates (P < 0.001), intra-operative (P= 0.001) and postoperative (P < 0.001) complication rates, and the mortality rate (P= 0.007). • Most elderly were treated at low or intermediate AHC (68.5%) and non-academic centres (56.2%). • Within the elderly cohort, intra-operative (2.9%) and postoperative (22.2%) complications tended to be highest at low AHC institutions compared to institutions of intermediate (2.7% and 17.4%) and high AHC (1.7% and 14.5%). Similarly, intra-operative (2.7% vs 2.1%) and postoperative complications (19.1% vs 13.9%) tended to be higher at non-academic than academic centres. • In multivariable analyses performed in the elderly subgroup, low AHC predicted higher intra-operative complications and higher homologous transfusions, whereas non-academic status predicted higher postoperative complications.
  
  
  CONCLUSIONS
  • Adverse outcomes are more often recorded in the elderly. • Most elderly are treated at institutions where suboptimal outcomes are recorded.
authors: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA. trinh.qd@gmail.com
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Jan
authors: J
authors: Schmitges
authors: Maxine
authors: M
authors: Sun
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Shyam
authors: S
authors: Sukumar
authors: Zhe
authors: Z
authors: Tian
authors: Marco
authors: M
authors: Bianchi
authors: Jesse
authors: J
authors: Sammon
authors: Paul
authors: P
authors: Perrotte
authors: Craig G
authors: CG
authors: Rogers
authors: Markus
authors: M
authors: Graefen
authors: James O
authors: JO
authors: Peabody
authors: Mani
authors: M
authors: Menon
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000367:Age Factors; D000368:Aged; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology