Mortality of Patients after Radical Prostatectomy: Analysis of Recent Medicare Claims

Mark, David H.

doi:10.1016/s0022-5347(17)32602-2

Cited by 40 publications

(14 citation statements)

References 6 publications

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“…A statistically significant number of patients had [1984][1985][1986][1987][1988][1989][1990] could reflect the experience of many urologie surgeons who were just beginning to perform radical prostatectomy, rather than the results of experi enced surgeons. In contrast, reports from individual sur geons or hospitals [3,4] and later statistics from US gov ernment agencies [7,8] show acceptably low early mor bidity and mortality. These data might reflect the growth in experience in radical prostatectomy that occurs in sin gle institutions [3].…”

Section: Introductionmentioning

confidence: 88%

Early Complication of Anatomical Radical Retropubic Prostatectomy: Lessons from a Single-Center Experience

et al. 1997

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Objectives: The purpose of this study is to report the rate of early complications in 316 of 600 patients who underwent anatomical radical retropubic prostatectomy for localized prostatic cancer from June 1988 to July 1996 and to measure the effect of increasing experience in a single institution. Methods: From January 1992 to August 1995, 316 patients with prostatic cancer underwent anatomical radical retropubic prostatectomy at our medical institution. Early complications were recorded prospectively and the rate of complications of the first 166 patients was compared with the rate in the next 150 patients. Results: Comparison of the 2 groups showed a significant decrease in blood loss with time (mean 1,397 vs. 967 cm3, p = 0.0011). The rates of anastomotic urinary leakage (21.7 vs. 10%, p = 0.0056), lymphoceles (22.3 vs. 2%, p < 0.0001), rectal injury (7.8 vs. 2%, p = 0.02), reoperation (10.2 vs. 4%, p = 0.049), and thromboembolic complications (7.8 vs. 2.7%, p = 0.0479) also decreased significantly. Only ureteral transsection showed an increase in the later group (0 vs. 4.7%, p = 0.005). Conclusions: The low percentage of early complications suggests that anatomical retropubic radical prostatectomy is a safe approach. Our single-center study showed a learning pattern that appears unavoidable when this operation is as radical as possible so as to keep the percentage of positive margins low especially in patients with advanced tumors ( > pT2).

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Section: Introductionmentioning

confidence: 88%

Early Complication of Anatomical Radical Retropubic Prostatectomy: Lessons from a Single-Center Experience

et al. 1997

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“…This analysis assumes a peri-operative mortality rate of 0.3% which is consistent with published results of several series of radical prostatectomies 8,10,11 as well as a review of 100% of Medicare claims data. 12 The years of life lost (ie life expectancy) in the men who suffer peri-operative deaths (including both men with organ confined and nonorgan confined disease) are subtracted from the total number of years of life saved by screening.…”

Section: Methods the Screening Modelmentioning

confidence: 99%

“…This estimate is well supported by large, published series of RP and an analysis of 100% of Medicare data on patients who underwent RP. 12 However, other studies which have attempted to define the cost effectiveness of prostate cancer screening have used a peri-operative mortality rate of 1.1% based on older series of RP and incomplete Medicare data. 1,2 A surgical mortality rate of 1.1% in the present analysis would have resulted in an increase in the cost per life year saved of 0.88% for men aged 50 -69 screened with PSA and DRE, and 0.83% for men aged 50 -70 screened with PSA alone.…”

Section: Sensitivity Analysismentioning

confidence: 99%

A quantitative analysis of the costs and benefits of prostate cancer screening

Benoit

Grönberg

Naslund

2001

Prostate Cancer Prostatic Dis

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The present study attempts to quantitate in an economically and clinically meaningful manner the cost and cost-effectiveness of prostate cancer screening and subsequent treatment, including complications from that treatment. Outcome data from large prostate cancer screening trials using prostate specific antigen (PSA) and digital rectal examination (DRE) and PSA alone were used to construct the screening model. The benefit of screening is expressed in years of life saved by screening, which is calculated by comparing the survival rate of men with prostate cancer to the survival rate of men in the general population. The cost of screening, treatment, and complications were estimated using the Medicare data base and published reports on the cost, morbidity and mortality for radical prostatectomy. The cost per year of life saved by prostate cancer screening with PSA and DRE was $2339 -3005 for men aged 50 -59, $3905 -5070 for men aged 60 -69, and $3574 -4627 overall for men aged 50 -69. The cost per year of life saved by prostate cancer screening with PSA alone for men aged 50 -70 was $3822 -4956. A sensitivity analysis demonstrates that the cost per year of life saved by prostate cancer screening will not change substantially even if the assumptions in this model have been underestimated or overestimated by 100%. This study quantifies only those parameters which can be reliably compared in concrete terms such as dollars, treatment impact on survival, published complication rates and published treatment costs. Using this type of analysis, prostate cancer screening appears to be a cost-effective intervention. However, the issue of whether prostate cancer screening is cost-effective will be decided definitively only when randomized, controlled trials are available to quantify the costs and benefits of prostate cancer screening. Prostate Cancer and Prostatic Diseases (2001) 4, 138-145.

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“…In tors using the complete Medicare data base for 1990 observed a postoperative mortality rate of only 0.5%, a New York Medicare beneficiary population studied by Imperato et al 14 the rate of radical prostatectomy a figure much closer to those reported in the current study. 9 In another large series, Zincke et al reported in 1991 was 70% greater in white patients compared with African Americans. By 1993 this imbalance had 0.7% mortality within 30 days of surgery in 1123 patients treated at the Mayo Clinic.…”

Section: Discussionmentioning

confidence: 93%