Felix Preisser1, Elio Mazzone2, Sebastiano Nazzani3, Sophie Knipper4, Zhe Tian5, Philipp Mandel6, Raisa Pompe7, Fred Saad8, Francesco Montorsi9, Shahrokh F Shariat10, Hartwig Huland4, Markus Graefen4, Derya Tilki11, Pierre I Karakiewicz8. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: felixpreisser@gmx.de. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 4. Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada. 6. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. 7. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 8. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada. 9. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 10. Department of Urology, Medical University of Vienna, Vienna, Austria. 11. Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: Radical prostatectomy (RP) represents one standard of care for patients with localized prostate cancer and is associated with several established postoperative complications. OBJECTIVE: We tested the relationship between RP early postoperative outcomes and age within a population-based data repository. DESIGN, SETTING, AND PARTICIPANTS: Within the National Inpatient Sample database (2008-2013), we identified patients who underwent robotically assisted or open RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable logistic regression (MLR), multivariable Poisson regression (MPR), and linear regression models were used. Cubic spline graphically depicted the relationship between age and complications. RESULTS AND LIMITATIONS: Overall, 68780 patients underwent RP with a median age of 62 yr (interquartile range: 57-67 yr). In MLR models, patient age represented an independent predictor of overall [odds ratio (OR): 1.02, p<0.001], intraoperative (OR: 1.03, p<0.001), cardiac (OR: 1.03, p<0.001), miscellaneous medical (OR: 1.02, p<0.001), miscellaneous surgical (OR: 1.01, p=0.01), pulmonary (OR: 1.02, p<0.001), and vascular complications (OR: 1.05, p<0.001); blood transfusions (OR: 1.02, p<0.001); and bowel obstruction (OR: 1.02, p<0.001). In MPR models, patient age was associated with longer stay (OR: 1.001, p=0.02). Similar results were recorded after adjustment for clustering in stratified analyses (<70 vs ≥70 yr) and in the subgroup of patients that underwent robotically assisted RP. For nine out of twelve examined outcomes, a virtually direct relationship existed with increasing age, in cubic spline analyses. CONCLUSIONS: Virtually all early postoperative RP complications are directly related to age. In consequence, these observations should be considered from an individual patient perspective as well as from a health management perspective. PATIENT SUMMARY: RP is provided through a wide patient age spectrum. Virtually all early postoperative RP complications are directly related to age. Individual patient's age needs to be considered in treatment decision-making.
BACKGROUND: Radical prostatectomy (RP) represents one standard of care for patients with localized prostate cancer and is associated with several established postoperative complications. OBJECTIVE: We tested the relationship between RP early postoperative outcomes and age within a population-based data repository. DESIGN, SETTING, AND PARTICIPANTS: Within the National Inpatient Sample database (2008-2013), we identified patients who underwent robotically assisted or open RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable logistic regression (MLR), multivariable Poisson regression (MPR), and linear regression models were used. Cubic spline graphically depicted the relationship between age and complications. RESULTS AND LIMITATIONS: Overall, 68780 patients underwent RP with a median age of 62 yr (interquartile range: 57-67 yr). In MLR models, patient age represented an independent predictor of overall [odds ratio (OR): 1.02, p<0.001], intraoperative (OR: 1.03, p<0.001), cardiac (OR: 1.03, p<0.001), miscellaneous medical (OR: 1.02, p<0.001), miscellaneous surgical (OR: 1.01, p=0.01), pulmonary (OR: 1.02, p<0.001), and vascular complications (OR: 1.05, p<0.001); blood transfusions (OR: 1.02, p<0.001); and bowel obstruction (OR: 1.02, p<0.001). In MPR models, patient age was associated with longer stay (OR: 1.001, p=0.02). Similar results were recorded after adjustment for clustering in stratified analyses (<70 vs ≥70 yr) and in the subgroup of patients that underwent robotically assisted RP. For nine out of twelve examined outcomes, a virtually direct relationship existed with increasing age, in cubic spline analyses. CONCLUSIONS: Virtually all early postoperative RP complications are directly related to age. In consequence, these observations should be considered from an individual patient perspective as well as from a health management perspective. PATIENT SUMMARY: RP is provided through a wide patient age spectrum. Virtually all early postoperative RP complications are directly related to age. Individual patient's age needs to be considered in treatment decision-making.
Authors: Kirsti Aas; Sophie Dorothea Fosså; Tor Åge Myklebust; Bjørn Møller; Rune Kvåle; Ljiljana Vlatkovic; Viktor Berge Journal: Cancer Med Date: 2020-08-04 Impact factor: 4.452