title: Postoperative mortality 90 days after robot-assisted laparoscopic prostatectomy and retropubic radical prostatectomy: a nationwide population-based study.
abstract: To assess 90-day postoperative mortality after robot-assisted laparoscopic radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) using nationwide population-based registry data.
  
  
  
  We conducted a cohort study using the National Prostate Cancer Register of Sweden, including 22 344 men with localized prostate cancer of clinical stage T1-T3, whose prostate-specific antigen levels were <50 μg/mL and who had undergone primary radical prostatectomy in the period 1998-2012. Vital status was ascertained through the Total Population Register. The rates for 90-day postoperative mortality were analysed using logistic regression analysis, and comparisons of 90-day mortality with the background population were made using standardized mortality ratios (SMRs).
  
  
  
  Of the 14 820 men who underwent RRP, 29 (0.20%) died, and of the 7 524 men who underwent RARP, 10 (0.13%) died. Mortality in the cohort during the 90-day postoperative period was lower than in an age-matched background population: SMR 0.57 (95% confidence interval [CI] 0.39-0.75). There was no statistically significant difference in 90-day mortality according to surgical method: RARP vs RRP odds ratio (OR) 1.14; 95% CI 0.46-2.81. Postoperative 90-day mortality decreased over time: 2008-2012 vs 1998-2007 OR 0.44; 95% CI 0.21-0.95, mainly because of lower mortality after RARP.
  
  
  
  The 90-day postoperative mortality rates were low after RARP and RRP and there was no statistically significant difference between the methods. Given the long life expectancy among men with low- and intermediate-risk prostate cancer, very low postoperative mortality is a prerequisite for RP, which was fulfilled by both RRP and RARP. The selection of healthy men for RP is highlighted by the lower 90-day mortality after RP compared with the background population.
authors.affiliation: Department of Urology, Karolinska University Hospital, Solna, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Björklund
authors.affiliation: Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Folkvaljon
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cole
authors.affiliation: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.affiliation: Department of Urology, Ryhov County Hospital, Jönköping, Sweden.|Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.affiliation: Department of Urology Population Health, the Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.affiliation: Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.|Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
authors.affiliation: Department of Urology, Karolinska University Hospital, Solna, Sweden.|Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Akre
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D065287:Robotic Surgical Procedures; D013548:Sweden; D013997:Time Factors
keywords: 90-day postoperative; mortality; prostate cancer; radical prostatectomy; retropubic prostatectomy; robot assisted laparoscopic prostatectomy