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Is age an independent risk factor for medical complications following robotic-assisted laparoscopic radical prostatectomy? An evaluation of National Surgical Quality Improvement Program (NSQIP) data
Lawrence M. Dagrosa, MD, Ivan P. Gorlov, PhD, Elias S. Hyams, MD.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Background: While radical prostatectomy is a first-line treatment for prostate cancer, the risk of medical complications in older patients can be a deterrent to surgical therapy in those who may otherwise benefit. We sought to evaluate whether medical complications are independently associated with age in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALRP).
Methods: Retrospective analysis of prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data was performed. Patients undergoing RALRP between 2009 and 2012 were identified. Demographic and comorbidity data were collated, and medical complications occurring during the 30-day postoperative period were identified. Age-related comorbidities were identified by univariate analysis, and complications associated with these comorbidities were identified. Multiple linear regression was then performed to assess whether age was an independent risk factor for these complications.
Results: Between 2009-2012, 12,123 patients underwent RALRP within the NSQIP database. Univariate analysis demonstrated that 9 comorbidities were associated with age: history of congestive heart failure, myocardial infarction (MI), cerebrovascular attack (CVA), transient ischemic attack (TIA), bleeding disorder, chronic obstructive pulmonary disease, percutaneous coronary intervention, cardiac surgery and ASA class (p<0.05). Five post-operative medical complications were associated with age-related comorbidities: MI, CVA, pneumonia (PNA), deep venous thrombosis (DVT), pulmonary embolism (PE) and urinary tract infection (UTI). On multivariate analysis, age was found to be an independent risk factor for post-operative PNA (p<0.05), but not for MI (p=0.09) , UTI (p=0.3), CVA (p=0.2) or DVT/PE (p=0.7).
Conclusion: While patient age may generate concern for medical complications following surgery, our results suggest that age is not an independent risk factor for most medical complications after RALRP. RALRP can be safely performed in appropriately selected older patients with minimal increased risk for medical complications.
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