The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy

Pereira, Jorge; Golijanin, Dragan; Pareek, Gyan; Guo, Ruiting; Zhang, Zheng; Renzulli, Joseph; Gershman, Boris

doi:10.1016/j.urolonc.2017.11.019

Cited by 14 publications

(21 citation statements)

References 13 publications

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“…In this context, we found that independent predictors of the risk of RAD were seminal vesicle invasion, open approach, and performing ePLND. Moreover, our study confirmed the evidence reported by other studies showing that RARP decreases the risk of hospital readmission after surgery [6,7,28,[30][31][32]34].…”

Section: Overall Association Of Group Factors With the Risk Of Hospitsupporting

confidence: 91%

“…The incidence of hospital readmission after RP between 30 and 90 days after RP ranges from 3.3 to 9.7%, [6][7][8][28][29][30][31][32][33]. Particularly, readmission rates after ORP range between 5.47 and 10.7% [8,28,29,32,33], and readmission rates after LRP vary between 8.2 and 10.7% [21,22].…”

Section: Overall Association Of Group Factors With the Risk Of Hospitmentioning

confidence: 99%

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Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report

et al. 2020

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Objective: To evaluate the predictors of the risk of long-term hospital readmission after radical prostatectomy (RP) in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. Materials and Methods: The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the 2 surgical approaches. Patients were followed for complications and hospital readmission for a period of 6 months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. Results: From December 2013 to 2017, 885 patients underwent RP. RARP was performed in 733 cases and ORP in 152 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 479 patients. Hospital readmission was detected in 46 cases (5.2%). Using a multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (hazard ratio [HR] 2.065; 95% CI 1.116-3.283; p = 0.021), ORP (HR 3.506; 95% CI 1.919-6.405; p < 0.0001), and ePLND (HR 5.172; 95% CI 1.778-15.053; p < 0.0001). Conclusions: In a large single tertiary referral center, independent predictors of the risk of long-term hospital readmission after RP included ORP, ePLND, and seminal vesicle invasion. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of long-term hospital readmission and its related risk factors.

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Section: Overall Association Of Group Factors With the Risk Of Hospitsupporting

confidence: 91%

Section: Overall Association Of Group Factors With the Risk Of Hospitmentioning

confidence: 99%

Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report

et al. 2020

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“…As late effects of radiotherapy occur over many years and radiotherapy is used frequently for pelvic malignancies, including the most common male cancer (prostate cancer), the denominator is likely to be large.Highlighting information on the fistula rates was also potentially misleading, given a previous analysis and audit of prostate radiotherapy at the Austin Uro-Oncology department [3]. This showed a low toxicity profile and a low fistula rate among patients that was consistent with the published literature, which is 0.1% [4], not dissimilar to the reported 30-day mortality rate after prostatectomy [5] and similar to the severe urinary stricture rate after external beam radiotherapy alone.These severe complication figures would be more useful and more lessons would be learned if their occurrence were examined in light of the concomitant surgical procedures or endoscopic interventions [6]. Severe late radiation complications are more common when external beam radiotherapy is associated with prostatectomy and brachytherapy.…”

mentioning

confidence: 63%

“…Highlighting information on the fistula rates was also potentially misleading, given a previous analysis and audit of prostate radiotherapy at the Austin Uro-Oncology department [3]. This showed a low toxicity profile and a low fistula rate among patients that was consistent with the published literature, which is 0.1% [4], not dissimilar to the reported 30-day mortality rate after prostatectomy [5] and similar to the severe urinary stricture rate after external beam radiotherapy alone.…”

mentioning

confidence: 63%

The collaborative management of late urological complications after radiation therapy

et al. 2019

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The importance of a multidisciplinary collaborative approach to urological radiation complications is highlighted in a recent study by Ma et al. [1]. Their single-centre retrospective study adds to the existing body of knowledge, and the controversy in the field, regarding radiotherapy complications and toxicities from the urological perspective. The work provides some meaningful information about a subsection of patients presenting to one of the largest urology units in Australia. Furthermore, the study is well critiqued by the accompanying editorial that underscores many of the issues [2]. The Austin urology unit has a strong partnership in urooncology with radiation and medical oncology. Consequently it has developed considerable expertise in the management of uro-oncology complications.Nevertheless, some aspects of this study could be improved to produce more robust data. One such aspect is the number of patients included in the case series, which represented only a 6-month snapshot of patients who had a median (interquartile range) time to onset of complications of 4 (1-9) years. Furthermore, the sample represented only a small fraction of patients from one discipline rather than the entire department, which is made up of multiple disciplines including radiation oncology and medical oncology. The severe complication rates across the oncology disciplines, surgery, chemotherapy and radiotherapy are similar but they differ in their type and timing. Defining late radiotherapy complications can be difficult, particularly without radiation oncology input, including dosimetry, because they can occur years after treatment and can be confused with disease progression or other traumatic events.Notably, the urology unit represents one of the largest in the state and has a strong collaborative relationship with radiation oncology. Thus, it expertly manages radiotherapy complications from many other large centres besides the Austin centre. This would imply that the published sample was not truly reflective of the patients treated solely by the Austin Radiation Oncology Department. The editorial notes that almost two-thirds of patients were treated with standard external beam radiotherapy. It also highlights that <20% were treated with intensity-modulated radiotherapy, a superior technique that has been shown to reduce toxicity, which is further diminished with image-guided radiotherapy [2]. The Austin centre has treated all patients with prostate cancer with intensity-modulated radiotherapy and imageguided radiotherapy for more than a decade. Consequently, measures of frequency, incidence and prevalence; that is, how common the complications are, cannot be calculated because the denominator in terms of patients at risk and period of time is unknown. As late effects of radiotherapy occur over many years and radiotherapy is used frequently for pelvic malignancies, including the most common male cancer (prostate cancer), the denominator is likely to be large.Highlighting information on the fistula rates was also potentially...

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“…Recently, Pereira et al [4] performed a formal analysis, examining the relationship between age and a number of adverse postoperative surgical outcomes, within the National Surgical Quality Improvement Program (NSQIP) database. Among 35 968 RP patients studied a direct age relationship was reported for 30-d overall complications, blood transfusions, and readmissions.…”

Section: Introductionmentioning

confidence: 99%

Impact of Age on Perioperative Outcomes at Radical Prostatectomy: A Population-Based Study

Preißer

Mazzone²,

Nazzani³

et al. 2020

European Urology Focus

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The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy

Cited by 14 publications

References 13 publications

Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report

Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report

The collaborative management of late urological complications after radiation therapy

Impact of Age on Perioperative Outcomes at Radical Prostatectomy: A Population-Based Study

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