title: Morbidity and costs of salvage vs. primary radical prostatectomy in older men.
abstract: OBJECTIVE
  Salvage radical prostatectomy (RP) is performed with curative intent following post-radiotherapy recurrence for prostate cancer. While single-center salvage RP outcomes appear promising, little is known about outcomes in the community setting in elderly men. We sought to evaluate utilization, outcomes, and costs of salvage RP vs. primary RP in older men.
  
  
  METHODS
  Surveillance, Epidemiology and End Results-Medicare linked data from 1992 to 2007 was used to identify 18,317 men aged 65 years or older who underwent RP from 2002 to 2007. Propensity score analyses were used to compare outcomes and costs for primary vs. salvage RP.
  
  
  RESULTS
  Salvage RP was rare, accounting for 0.5% of RP. Men undergoing salvage vs. primary RP were older, white, and less likely to undergo CT, bone scan and prostate biopsy preoperatively (P < 0.05 for all). In adjusted analyses, salvage vs. primary RP was associated with increased 30-day complications (60.1% vs. 22.7%, P < 0.01), lengths of stay (mean 7 vs. 3 days, P < 0.01), and hospital readmissions within 30 days (30.4% vs. 5.7%, P < 0.01). The odds of death within 90 days were higher for salvage vs. primary RP (OR 26.7, 95% CI 12.9-55.1, P < 0.01). The median expenditure for salvage RP within 6 months postoperatively was almost twice that for primary RP (US$30,881 vs. US$12,431, P < 0.01).
  
  
  CONCLUSIONS
  Metastatic workup was performed less frequently before salvage vs. primary RP, and morbidity and mortality for salvage RP was high relative to primary RP. Given the morbidity and high cost of salvage RP, guidelines for patient selection and selective referral may optimize outcomes, especially in older men.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Sandip M
authors.initials: SM
authors.lastname: Prasad
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009017:Morbidity; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D018426:SEER Program / Q000706:statistics & numerical data; D016879:Salvage Therapy / Q000191:economics / Q000379:methods*; D014481:United States / Q000453:epidemiology