The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy

Older age is considered a relative contraindication to radical prostatectomy (RP). However, data are limited regarding the impact of age on perioperative outcomes following RP. We examined the association of age with perioperative outcomes following RP to inform risk-stratification and management.

We identified 35,968 men aged 18 to 89 years who underwent RP from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database. The associations of age with 30-day complications and perioperative morbidity were evaluated using logistic regression, adjusted for patient features. Age was modeled both as a categorical and nonlinear continuous variable.

Median age at surgery was 63 years (IQR: 58-67). Increasing age was associated with greater rates of perioperative morbidity. Compared to men aged<60 years, men aged 70 to 89 years had statistically significantly higher rates of 30-day complications (6.4% vs. 4.4%, P<0.0001), perioperative blood transfusion (6.0% vs. 3.7%, P<0.0001), readmission (4.9% vs. 3.9%, P<0001), and 30-day mortality (0.3% vs. 0.1%, P<0.0001). In multivariable analyses, older age was independently associated with increased risks of perioperative morbidity. Moreover, there was a nonlinear relationship of age with perioperative morbidity, wherein rates of 30-day complications, perioperative blood transfusion, and readmission increased after approximately 70 years of age.

In this national cohort, we observed a nonlinear association of age with perioperative morbidity, with increasing rates of 30-day complications, perioperative blood transfusion, and readmission after approximately 70 years of age. These results have implications for risk-stratification, patient counseling, and treatment selection among older men.