Elsevier

Urology

Volume 52, Issue 6, December 1998, Pages 1041-1046
Urology

Adult Urologies
Thirty-day mortality rates and cumulative survival after radical retropubic prostatectomy

https://doi.org/10.1016/S0090-4295(98)00350-1Get rights and content

Abstract

Objectives. To assess the 30-day mortality rate and overall survival after radical retropubic prostatectomy (RRP).

Methods. Identification of all RRPs performed in the Province of Quebec between January 5, 1988 and January 16, 1996 was accomplished through the Quebec Healthcare Plan Database.

Results. Four thousand nine hundred ninety-seven RRPs were performed by 104 urologists. Overall, 451 deaths were recorded: 32 occurred during the first 30 days (0.6% 30-day mortality rate). A significant decrease in the 30-day mortality rate, from 2.45% to 0.5%, was recorded during the span of the study. The year of surgery, patient age, and hospital type were statistically significant short-term mortality variables (life table analysis). Patient age and year of surgery determined the cumulative survival probability (univariate and multivariate Cox analysis). Cumulative survival at 31 months of follow-up increased from 88.2% in 1988 to 98.1% in 1995. Men 75 years old and older were at a clear disadvantage with regard to survival probability compared with their younger counterparts.

Conclusions. In this population-based analysis of RRP outcomes, we demonstrated a significant improvement in short- and long-term outcomes, as evidenced by a decrease in the 30-day mortality rate and an improved cumulative survival, recorded over the span of the study. The recorded outcome trends may be explained by improved patient selection and optimal management. Although we are unable to determine cancer-specific outcomes, the results of this analysis should prove valuable to urologists and patients until there are results from randomized trials.

Section snippets

Material and methods

The Quebec Healthcare Plan is the exclusive insurance plan in the Province of Quebec. As such, all RRP reimbursements, identified by its specific billing code, can be traced in the Healthcare Plan Database. Relying on the Plan Database, we obtained an anonymously coded list of all RRPs performed in the Province of Quebec between January 5, 1988 and January 16, 1996. All procedures were accompanied by their respective date and the type of hospital where they were performed. The hospitals

Results

According to the Quebec Healthcare Plan Database, 4997 consecutive men underwent RRP during the period of this study (January 5, 1988 to January 16, 1996). Their age at the time of the RRP ranged from 31 to 83 years (mean 64, median 65). Table I contains further descriptive statistics pertaining to the study population and the annual RRP trends. Figure 1 demonstrates the number of RRPs performed by each of the 104 urologists during the study period. Overall, 451 deaths (9.0% overall death

Comment

Although this large-scale, population-based study was not designed to assess cancer-specific outcomes associated with RRP, it allows several important observations. Our results demonstrate a significant improvement in outcomes over time, as evidenced by decreasing 30-day mortality rates and improving overall survival. These findings confirm the initial hypothesis of improved patient selection and optimized intraoperative and postoperative care. Therefore, the practicing urologists and patients

Conclusions

In this large, population-based analysis of RRP outcomes, we demonstrated that current RRP outcomes translate into negligible (0.5%) 30-day mortality and excellent overall survival (98.1% at 31 months of follow-up). These trends substantially improved over the 8 years spanning the study and will probably continue to improve in the future. The recorded outcome trends may be accounted for by improved patient selection and care. Although we are unable to determine cancer-specific outcomes, the

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This work was supported by a grant from Zeneca Pharmaceuticals.

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