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Related Experiment Videos

Mortality after prostatectomy: selection and surgical approach

V Seagroatt1

  • 1Department of Public Health and Primary Care, University of Oxford, Headington, UK.

Lancet (London, England)
|December 9, 1995
PubMed
Summary

Transurethral prostatectomy (TURP) does not increase long-term mortality compared to open prostatectomy (OP). Apparent excess mortality after TURP is likely due to healthier patients undergoing OP, not the TURP procedure itself.

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Area of Science:

  • Urology
  • Surgical Outcomes Research
  • Epidemiology

Background:

  • Observational studies suggest higher long-term mortality following transurethral prostatectomy (TURP) compared to open prostatectomy (OP).
  • This observed difference has been attributed to the TURP procedure itself, even after adjusting for patient comorbidities.
  • This study aims to reassess the association between prostatectomy type and long-term mortality.

Purpose of the Study:

  • To investigate the long-term mortality rates associated with transurethral prostatectomy (TURP) versus open prostatectomy (OP).
  • To determine if the TURP procedure itself contributes to increased long-term mortality.
  • To analyze trends in mortality rates as TURP replaced OP over time.

Main Methods:

  • Analysis of time-sequenced hospital and death records for 13,815 men undergoing prostatectomy (excluding cancer) between 1963-1985.

Related Experiment Videos

  • Comparison of 30-day, 90-day, and one-year case-fatality rates between TURP and OP groups.
  • Calculation of standardized mortality ratios (SMRs) for the second and third postoperative years to assess long-term mortality.

    • Main Results:

    • TURP demonstrated lower 30-day and similar 90-day case-fatality rates compared to OP.
    • While TURP showed a higher one-year rate, long-term mortality (years 2-3 post-op) after TURP was close to expected population rates (SMR=100).
    • Long-term mortality after OP was lower than expected (SMR=79), suggesting OP patients were healthier, not that TURP caused excess mortality.

    Conclusions:

    • The apparent excess long-term mortality after TURP is unlikely to be a direct effect of the procedure.
    • The healthier status of patients undergoing open prostatectomy likely accounts for their lower long-term mortality.
    • This reassessment challenges previous attributions of higher mortality to the TURP procedure itself.