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Problems of comorbidity in mortality after prostatectomy.
J Concato1, R I Horwitz, A R Feinstein
1Department of Medicine, Yale University School of Medicine, New Haven, Conn.
JAMA
|February 26, 1992
Summary
Transurethral resection of the prostate (TURP) does not increase long-term mortality for benign prostatic hyperplasia (BPH) patients. Adjusting for patient health status at surgery is crucial for accurate outcome comparisons.
Area of Science:
- Urology
- Surgical Outcomes Research
- Health Services Research
Background:
- Previous studies indicated higher long-term mortality in benign prostatic hyperplasia (BPH) patients after transurethral resection of the prostate (TURP) compared to open prostatectomy.
- A potential confounding factor was the possibility that TURP patients were older and had more severe comorbidities at the time of surgery.
Purpose of the Study:
- To investigate whether the observed higher mortality in TURP patients was due to differences in age and comorbidity severity at the time of surgery.
- To test the hypothesis that adjusted outcomes would equalize mortality rates between TURP and open prostatectomy for BPH.
Main Methods:
- Retrospective cohort study involving 252 men who underwent TURP or open prostatectomy for BPH between 1979 and 1981.
- Five-year mortality was analyzed, with adjustments made for patient age and severity of comorbid illness at the time of surgery.
- Statistical analyses, including Mantel-Haenszel relative risk, were employed with increasing detail in comorbidity assessment.
Main Results:
- Crude 5-year mortality rates were 17.5% for TURP and 13.5% for open prostatectomy.
- Patients undergoing TURP were found to be older and sicker than those undergoing open prostatectomy.
- After adjusting for age and comorbidity, the difference in mortality between the two surgical groups diminished, with no statistically significant effect of prostatectomy type on long-term mortality (RR, 1.03; 95% CI, 0.57 to 1.87).
Conclusions:
- Transurethral resection of the prostate (TURP) does not appear to increase long-term mortality in patients treated for benign prostatic hyperplasia (BPH).
- Inadequate accounting for patient illness severity can significantly impact the interpretation of outcomes research, potentially leading to biased results.
- This study highlights the importance of robust comorbidity adjustment in comparative effectiveness research.
