Key result
In elderly patients undergoing open radical prostatectomy, low annual hospital caseload was associated with higher intra-operative (2.9% vs 1.7%) and postoperative (22.2% vs 14.5%) complications.
Why the study?
Do annual hospital caseload and academic status affect adverse outcomes after open radical prostatectomy in elderly patients?
Observational (n=115,554)
Yes
Do annual hospital caseload and academic status affect adverse outcomes after open radical prostatectomy in elderly patients?
Elderly patients undergoing open radical prostatectomy have higher rates of adverse outcomes, which are further exacerbated when treated at low-volume or non-academic centers.
May support referral to high-volume centers for elderly open prostatectomy; leaves open prospective confirmation of benefit.
UNLABELLED: Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Adverse outcomes after radical prostatectomy are more often recorded in the elderly. In the USA, elderly patients undergoing radical prostatectomy are treated at institutions where suboptimal outcomes are recorded. OBJECTIVE: • To assess the rate of adverse outcomes after open radical prostatectomy (ORP) in the elderly and to examine the effect of annual hospital caseload (AHC) and academic institutional status on adverse outcomes in these of patients. PATIENTS AND METHODS: • Within the Health Care Utilization Project Nationwide Inpatient Sample, we focused on ORPs performed between 1998 and 2007. Subsequently, we restricted to patients aged ≥75 years. • In both datasets, we examined transfusion rates, intra-operative and postoperative complication rates, and in-hospital mortality rates. • Stratification was performed according to AHC tertiles and academic status. • Multivariable logistic regression analyses were fitted. RESULTS: • Of 115,554 ORP patients, 2109 (1.8%) were aged ≥75 years. • In multivariable analyses performed in the entire cohort, elderly age increased homologous blood transfusion rates (P < 0.001), intra-operative (P= 0.001) and postoperative (P < 0.001) complication rates, and the mortality rate (P= 0.007). • Most elderly were treated at low or intermediate AHC (68.5%) and non-academic centres (56.2%). • Within the elderly cohort, intra-operative (2.9%) and postoperative (22.2%) complications tended to be highest at low AHC institutions compared to institutions of intermediate (2.7% and 17.4%) and high AHC (1.7% and 14.5%). Similarly, intra-operative (2.7% vs 2.1%) and postoperative complications (19.1% vs 13.9%) tended to be higher at non-academic than academic centres. • In multivariable analyses performed in the elderly subgroup, low AHC predicted higher intra-operative complications and higher homologous transfusions, whereas non-academic status predicted higher postoperative complications. CONCLUSIONS: • Adverse outcomes are more often recorded in the elderly. • Most elderly are treated at institutions where suboptimal outcomes are recorded.
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Trinh et al. (2011) conducted an observational in Prostate cancer (n=115,554). Open radical prostatectomy at low annual hospital caseload centers vs. High annual hospital caseload centers was evaluated on Transfusion rates, intra-operative and postoperative complication rates, and in-hospital mortality rates. In elderly patients undergoing open radical prostatectomy, low annual hospital caseload was associated with higher intra-operative (2.9% vs 1.7%) and postoperative (22.2% vs 14.5%) complications.
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