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Sood A, Meyer CP, Abdollah F, Sammon JD, Sun M, Lipsitz SR, Hollis M, Weissman JS, Menon M, Trinh QD. Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality. Br J Surg 2017. [PMID: 28632890 DOI: 10.1002/bjs.10561] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures. METHODS Patients undergoing appendicectomy, colectomy, inguinal hernia repair, hysterectomy and prostatectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Non-parsimonious propensity score methods were used to construct procedure-specific matched-pair cohorts that reduced baseline differences between patients who underwent MIS and those who did not. Bonferroni correction for multiple comparisons was applied and P < 0·006 was considered significant. RESULTS Of the 532 287 patients identified, 53·8 per cent underwent MIS. Propensity score matching yielded an overall sample of 327 736 patients (appendicectomy 46 688, colectomy 152 114, inguinal hernia repair 59 066, hysterectomy 59 066, prostatectomy 10 802). Within the procedure-specific matched pairs, MIS was associated with significantly lower odds of Clavien-Dindo grade I-II, III and IV complications (P ≤ 0·004), unplanned readmissions (P < 0·001) and reduced hospital stay (P < 0·001) in four of the five procedures studied, with the exception of inguinal hernia repair. The odds of death were lower in patients undergoing MIS colectomy (P < 0·001), hysterectomy (P = 0·002) and appendicectomy (P = 0·002). CONCLUSION MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.
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Affiliation(s)
- A Sood
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C P Meyer
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - F Abdollah
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - J D Sammon
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Sun
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - S R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Hollis
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J S Weissman
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Menon
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Q-D Trinh
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abdollah F, Sammon JD, Reznor G, Sood A, Schmid M, Klett DE, Sun M, Aizer AA, Choueiri TK, Hu JC, Kim SP, Kibel AS, Nguyen PL, Menon M, Trinh QD. Medical androgen deprivation therapy and increased non-cancer mortality in non-metastatic prostate cancer patients aged ≥66 years. Eur J Surg Oncol 2015. [PMID: 26210655 DOI: 10.1016/j.ejso.2015.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine the potential relationship between androgen deprivation therapy and other-cause mortality (OCM) in patients with prostate cancer treated with medical primary-androgen deprivation therapy, prostatectomy, or radiation. METHODS A total of 137,524 patients with non-metastatic PCa treated between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included. Cox-regression analysis tested the association of ADT with OCM. A 40-item comorbidity score was used for adjustment. RESULTS Overall, 9.3% of patients harbored stage III-IV disease, and 57.7% of patients received ADT. The mean duration of ADT exposure was 22.9 months (median: 9.1; IQR: 2.8-31.5). Mean and median follow-up were 66.9, and 60.4 months, respectively. At 10 years, overall-OCM rate was 36.5%; it was 30.6% in patients treated without ADT vs. 40.1% in patients treated with ADT (p < 0.001). In multivariable-analysis, ADT was associated with an increased risk of OCM (Hazard-ratio [HR]: 1.11, 95% Confidence-interval [95% CI]: 1.08-1.13). Patients with no comorbidity (10-year OCM excess risk: 9%) were more subject to harm from ADT than patients with high comorbidity (10-year OCM excess risk: 4.7%). CONCLUSIONS In patients with PCa, treatment with medical ADT may increase the risk of mortality due to causes other than PCa. Whether this is a simple association or a cause-effect relationship is unknown and warrants further study in prospective studies.
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Affiliation(s)
- F Abdollah
- Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
| | - J D Sammon
- Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - G Reznor
- Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Sood
- Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - M Schmid
- Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D E Klett
- Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - M Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - A A Aizer
- Harvard Radiation Oncology Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T K Choueiri
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J C Hu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - S P Kim
- Department of Urology, Yale University, New Haven, CT, USA
| | - A S Kibel
- Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Menon
- Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Q-D Trinh
- Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gandaglia G, Karakiewicz PI, Abdollah F, Becker A, Roghmann F, Sammon JD, Kim SP, Perrotte P, Briganti A, Montorsi F, Trinh QD, Sun M. The effect of age at diagnosis on prostate cancer mortality: a grade-for-grade and stage-for-stage analysis. Eur J Surg Oncol 2014; 40:1706-15. [PMID: 24915856 DOI: 10.1016/j.ejso.2014.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the effect of advancing age on cancer-specific mortality (CSM) after radical prostatectomy (RP). MATERIALS AND METHODS Overall, 205,551 patients with PCa diagnosed between 1988 and 2009 within the Surveillance Epidemiology and End Results (SEER) database were included in the study. Patients were stratified according to age at diagnosis: ≤ 50, 51-60, 61-70, and ≥ 71 years. The 15-year cumulative incidence CSM rates were computed. Competing-risks regression models were performed to test the effect of age on CSM in the entire cohort, and for each grade (Gleason score 2-4, 5-7, and 8-10) and stage (pT2, pT3a, and pT3b) sub-cohorts. RESULTS Advancing age was associated with higher 15-year CSM rates (2.3 vs. 3.4 vs. 4.6 vs. 6.3% for patients aged ≤ 50 vs. 51-60 vs. 61-70 vs. ≥ 71 years, respectively; P < 0.001). In multivariable analyses, age at diagnosis was a significant predictor of CSM. This relationship was also observed in sub-analyses focusing on patients with Gleason score 5-7, and/or pT2 disease (all P ≤ 0.05). Conversely, age failed to reach the independent predictor status in men with Gleason score 2-4, 8-10, pT3a, and/or pT3b disease. CONCLUSIONS Advancing age increases the risk of CSM. However, when considering patients affected by more aggressive disease, age was not significantly associated with higher risk of dying from PCa. In high-risk patients, tumor characteristics rather than age should be considered when making treatment decisions.
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Affiliation(s)
- G Gandaglia
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - P I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - F Abdollah
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - A Becker
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Martiniclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Roghmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Ruhr-University Bochum, Germany
| | - J D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - S P Kim
- Department of Urology, Mayo Clinic, Rochester, NY, USA
| | - P Perrotte
- Department of Urology, University of Montreal Health Centre, Montreal, Canada
| | - A Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Q-D Trinh
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
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Rogers C, Sammon JD, Diaz M, Sukumar S, Hwang C, Peabody J, Menon M. Biochemical recurrence in 3,671 patients following robot-assisted radical prostatectomy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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