Login to Access Video or Poster Abstract: MP14-05
Sources of Funding: none

Introduction

Older age has been considered a relative contraindication to radical prostatectomy (RP) in men who are otherwise candidates for definitive local therapy for prostate cancer. However, there are limited data regarding the association of age with perioperative outcomes following RP, which is particularly relevant given increased life expectancy in the United States. We therefore examined the association of age with perioperative outcomes among men undergoing RP to more fully inform risk-assessment and management._x000D_

Methods

We identified 35,968 adult patients aged 18-89 years who underwent open or minimally invasive RP from 2010-2015 in the National Surgical Quality Improvement Program (NSQIP) database. Age was modeled as a categorical variable. Thirty-day complications and perioperative outcomes were assessed using a standardized protocol as part of the NSQIP. The associations of age with 30-day complications and perioperative outcomes were evaluated using logistic regression, adjusted for patient features._x000D_

Results

Age at surgery was distributed as follows: <60 years in 12,172 (33.8%) patients, 60-69 years in 18,076 (50.3%) patients, 70-79 years in 5,480 (15.2%) patients, and 80-89 years in 240 (0.7%) patients. Median operative time was 191 (IQR 151, 191) minutes. There were statistically significant differences in several baseline characteristics across age strata, with higher American Society of Anesthesiology (ASA) class and greater prevalence of diabetes, chronic obstructive pulmonary disease, hypertension, and renal failure among older patients. Overall, 30-day complications occurred in 1,798 (5%) patients. In multivariable analyses adjusted for patient features and surgical approach, ages 70-79 and 80-89 years were statistically significantly associated with increased risks of 30-day complications (OR 1.24, p=0.01; OR 2.83, p<0.01, respectively), perioperative blood transfusion (OR 1.25, p=0.01; OR 3.89, p<0.01, respectively) and 30-day mortality (OR 2.24, p=0.05; OR 10.02, p<0.01, respectively). Only the 80-89 years age group was associated with an increased risk of readmissions (OR 1.75, p=0.03). _x000D_

Conclusions

In this national, surgical cohort, older age was independently associated with increased risks of 30-day complications, perioperative blood transfusion, hospital readmissions, and 30-day mortality. However, there were no statistically significant differences among men younger than 70 years for all perioperative endpoints. These results have implications for patient counseling and decision making._x000D_

Funding

none