MP4-19 NINETY-DAY PERIOPERATIVE MORTALITY IN RADICAL PROSTATECTOMY AMONG SWEDISH MEN 1998 TO 2012

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2015MP4-19 NINETY-DAY PERIOPERATIVE MORTALITY IN RADICAL PROSTATECTOMY AMONG SWEDISH MEN 1998 TO 2012 Alexander P. Cole, Johan Björklund, Yasin Folkvaljon, Stefan Carlsson, David Robinson, Stacy Loeb, Pär Stattin, and Olof Akre Alexander P. ColeAlexander P. Cole More articles by this author , Johan BjörklundJohan Björklund More articles by this author , Yasin FolkvaljonYasin Folkvaljon More articles by this author , Stefan CarlssonStefan Carlsson More articles by this author , David RobinsonDavid Robinson More articles by this author , Stacy LoebStacy Loeb More articles by this author , Pär StattinPär Stattin More articles by this author , and Olof AkreOlof Akre More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.162AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A large body of evidence has shown that retropubic radical prostatectomy (RRP) is a safe procedure with low perioperative mortality. However, there is less data on mortality after robot-assisted laparoscopic prostatectomy (RALP). In 2011, RALP surpassed RRP as the most common method for RP in Sweden. We used nationwide population-based registry mortality data to assess differences in 90-day perioperative mortality between RRP and RALP, risk factors, and time trends. METHODS In the National Prostate Cancer Register (NPCR) of Sweden, we identified all men with clinical local stage T1-T3 tumors and PSA <50 ng/ml who underwent RP from 1998 through 2012. Vital status within the first 90 days after RP was ascertained by linkage with the Register for the Total Population and Changes. We calculated odds ratios (OR) for 90-day perioperative mortality using logistic regression controlling for age, educational level, tumor risk category, Charlson Comorbidity index (CCI), prostatectomy volume at hospital, and use of pelvic lymph node dissection. Standard mortality ratio (SMR) was assessed in comparison with an age-matched background population. RESULTS Among 14820 and 7524 men undergoing RRP and RALP, 29 (0.20%) and 10 (0.13%) men died within 90 days after surgery, respectively. Among the 5191 who underwent a RRP or RALP with a simultaneous pelvic lymph node dissection, 0.29% died within 90 days postoperatively. The mortality in the cohort was lower during the 90-day postoperative period than in an age-matched background population (SMR 0.63 (95% CI, 0.42 to 0.89) and 0.44 (95% CI, 0.21 to 0.78) for RRP and RALP, respectively). Comparing the mortality rate between the modalities, the adjusted odds ratio for RALP versus RRP was 0.90 (95% CI, 0.41 to 1.94). Age at surgery, being unmarried, and high tumor risk category all had a significant positive association with mortality in the entire study population. In the RALP cohort, mortality decreased in the latter half of the study period (OR, 3.95; 95% CI, 1.07 to 14.65 comparing 2002–7 v. 2008–12). CONCLUSIONS Perioperative mortality remains low and is decreasing further in the era of RALP. Given the long life expectancy among men with low and intermediate risk prostate cancer, very low perioperative mortality is a prerequisite for surgery. This was fulfilled by RRP and RALP performed across the entire nation of Sweden from 1998–2012. The strong selection of healthy men for PSA testing, diagnostic work-up, and subsequent RP is highlighted by the fact that risk of death within 90 days after RP was lower than in an age-matched background population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e34 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander P. Cole More articles by this author Johan Björklund More articles by this author Yasin Folkvaljon More articles by this author Stefan Carlsson More articles by this author David Robinson More articles by this author Stacy Loeb More articles by this author Pär Stattin More articles by this author Olof Akre More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...