Articles

Prostate Cancer

A Population-Based Analysis of Temporal Perioperative Complication Rates After Minimally Invasive Radical Prostatectomy

By: Jan Schmitgesa b 1 lowast , Quoc-Dien Trinhb c 1, Firas Abdollahd, Maxine Sunb, Marco Bianchid, Lars Budäuse, Kevin Zornb f, Paul Perotteb f, Thorsten Schlomma, Alexander Haesea, Francesco Montorsid, Mani Menonc, Markus Graefena and Pierre I. Karakiewiczb f

European Urology, Volume 60 Issue 1, September 2011, Pages 564-571

Published online: 01 September 2011

Keywords: Blood transfusion, Minimally invasive surgery, Perioperative complications, Prostatectomy, Prostatic neoplasms

Abstract Full Text Full Text PDF (492 KB)

Abstract

Background

Existing population-based reports on complication rates after minimally invasive radical prostatectomy (MIRP) did not address temporal trends.

Objective

To examine contemporary temporal trends in perioperative MIRP outcomes.

Design, setting, and participants

Between 2001 and 2007, 4387 patients undergoing MIRP were identified using the Nationwide Inpatient Sample.

Measurements

To examine the rates and trends of intraoperative and postoperative complications, transfusion rates, length of stay in excess of the median, and in-hospital mortality. We tested the effect of the late (2006–2007) versus the early (2001–2005) study period on all outcomes using multivariable logistic regression models controlled for clustering among hospitals.

Results and limitations

Intraoperative and postoperative complications decreased from 7.0% to 0.8% (p<0.001) and from 28.5% to 8.7% (p<0.001), respectively. Transfusion rates decreased from 3.5% to 2.1% (p=0.3). Hospital length of stay >2 d decreased from 56% to 15% (p<0.001). In multivariable analyses, intraoperative (odds ratio [OR]: 0.41; p=0.002) and postoperative (OR: 0.65; p=0.007) complications were less frequent in the late versus the early study period. Late study period patients were less likely to stay >2 d than early study period patients (OR: 0.34; p > 0.001). Limitations of these findings include the lack of adjustment for several patient variables including disease characteristics, surgeon variables including surgeon caseload, and the restriction to in-hospital events.

Conclusions

Our analyses demonstrate that in-hospital complication rates and length of stay after MIRP decreased over time. This implies that temporal differences specific to complication rates after MIRP must be considered when comparisons are made with other radical prostatectomy techniques.

Take Home Message

In-hospital complication rates and length of stay after minimally invasive radical prostatectomy (MIRP) decreased over time. This implies that temporal differences specific to complication rates after MIRP must be considered when comparisons are made with other radical prostatectomy techniques.

Keywords: Blood transfusion, Minimally invasive surgery, Perioperative complications, Prostatectomy, Prostatic neoplasms.

Footnotes

a Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany

b Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

c Vattikuti Urology Institute, Detroit, MI, USA

d Department of Urology, Vita Salute San Raffaele University, Milan, Italy

e Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

f Department of Urology, University of Montreal Health Center, Montreal, Canada

lowast Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, Québec, Canada H2X 3J4. Tel. +15144514351; Fax: +4932123666986.

1 Denotes equal contribution.

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