Is age an independent risk factor for medical complications following minimally invasive radical prostatectomy? An evaluation of contemporary American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) data

• Published in: Journal of robotic surgery Vol. 10; no. 4; pp. 343 - 346
• Main Authors: Dagrosa, Lawrence M., Ingimarsson, Johann P., Gorlov, Ivan P., Higgins, John H., Hyams, Elias S.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-12-2016; Springer Nature B.V
• Subjects: Adult; Age; Age Distribution; Age Factors; Age groups; Aged; Aged, 80 and over; Cancer surgery; Cancer therapies; Cardiovascular Diseases - complications; Chronic obstructive pulmonary disease; Comorbidity; Conflicts of interest; Heart attacks; Heart surgery; Hemorrhage - complications; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Mortality; Multivariate analysis; Original Article; Patient Safety; Patients; Pneumonia; Postoperative Complications - etiology; Prostate cancer; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - surgery; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary embolisms; Quality Improvement; Radiation therapy; Regression analysis; Regression models; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Stroke; Surgeons; Surgery; Surgical outcomes; Thrombosis; Transient ischemic attack; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - complications; Urogenital system; Urological surgery; Urology; Young Adult; Complications; Prostate cancer; Robotic prostatectomy; Age
• ISSN: 1863-2483; 1863-2491
• DOI: 10.1007/s11701-016-0605-9

While robotic-assisted laparoscopic radical prostatectomy (RALRP) is an effective treatment for localized prostate cancer, the risk of complications in older patients can be a deterrent to surgery. We evaluated the rate of medical complications following RALRP in a national dataset of safety events, and assessed whether age is an independent risk factor for these complications. Retrospective analysis of patients undergoing RALRP between 2009 and 2012 in the prospectively maintained American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was performed. Demographic and comorbid data were collated, medical complications occurring during the 30-day post-operative period were identified. We identified age-related comorbidities, and complications associated with these comorbidities. A binary logistic regression model with age and age-related comorbidities as predictors and specific complication as outcome, was used to evaluate whether age is an independent risk factor for these complications. 12,123 patients underwent RALRP between 2009 and 2012, with a mean age of 62 (22–92). Post-operative medical complications included urinary tract infection (UTI) (1.77 %), deep venous thrombosis (DVT) (0.67 %), pulmonary embolism (PE) (0.45 %), pneumonia (PNA) (0.27 %), myocardial infarction (MI) (0.12 %), and cerebrovascular accident (CVA) (0.01 %). Nine comorbidities were positively correlated with age (
p
 < 0.05). Four medical complications were associated with these age-related comorbidities: MI, CVA, PNA, and UTI. On multivariate analysis, age was an independent risk factor for post-operative PNA (
p
 < 0.05), but not for MI (
p
 = 0.09), UTI (
p
 = 0.3) or CVA (
p
 = 0.2). Patient age was independently associated with post-operative pneumonia only. These data suggest that RALRP can be considered as a treatment option in selected older patients with minimal increased risk for post-operative complications.