PMID- 18321316
OWN - NLM
STAT- MEDLINE
DCOM- 20080331
LR  - 20081121
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 101
IP  - 7
DP  - 2008 Apr
TI  - The effect of surgical volume, age and comorbidities on 30-day mortality after 
      radical prostatectomy: a population-based analysis of 9208 consecutive cases.
PG  - 826-32
LID - 10.1111/j.1464-410X.2007.07373.x [doi]
AB  - OBJECTIVES: To examine the effect of surgical volume (SV) on 30-day mortality 
      after radical prostatectomy (RP; reportedly 0.1-0.6% and influenced by age and 
      comorbidities) and to explore the most informative SV, age and comorbidity 
      thresholds to distinguish between high- and low-risk men. PATIENTS AND METHODS: 
      Between 1989 and 2000, 9208 consecutive patients were treated with RP. The 
      effects on 30-day mortality of (either continuously coded or categorized) patient 
      age, comorbidities (Charlson Comorbidity Index, CCI) and SV were tested in 
      multivariable logistic regression models. The models were corrected for overfit 
      bias using 200 bootstrap re-samples and were displayed graphically as nomograms. 
      RESULTS: The overall 30-day mortality was 0.52%; being younger (<69 years, 0.3% 
      vs 1.0% 30-day mortality otherwise, P < 0.001), lower CCI (0, 0.2% vs 0.8% 
      otherwise, P < 0.001) and higher SV (>27 RPs, 0.07 vs 0.6% otherwise, P = 0.049) 
      had a protective effect and represented independent predictors of 30-day 
      mortality. After correction for overfit bias, their combined input was 72.3% 
      accurate in predicting 30-day mortality, vs 67.1% (P < 0.001) when the same 
      variables were used in continuously coded (uncategorized) format. A model-derived 
      probability threshold of <or=0.1% resulted in a 99.9% negative predictive value. 
      CONCLUSIONS: SV is an important determinant of 30-day mortality. Categorized age, 
      CCI and SV are more useful and more accurate for predicting 30-day mortality than 
      continuously coded variables. The combination of young age (<69 years), a CCI of 
      0 and high SV (>27 RPs) can accurately identify patients at negligible risk of 
      30-day mortality.
FAU - Walz, Jochen
AU  - Walz J
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, 
      Quebec, Canada.
FAU - Montorsi, Francesco
AU  - Montorsi F
FAU - Jeldres, Claudio
AU  - Jeldres C
FAU - Suardi, Nazareno
AU  - Suardi N
FAU - Shariat, Shahrokh F
AU  - Shariat SF
FAU - Perrotte, Paul
AU  - Perrotte P
FAU - Arjane, Philippe
AU  - Arjane P
FAU - Graefen, Markus
AU  - Graefen M
FAU - Pharand, Daniel
AU  - Pharand D
FAU - Karakiewicz, Pierre I
AU  - Karakiewicz PI
LA  - eng
PT  - Journal Article
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Comorbidity
MH  - Epidemiologic Methods
MH  - General Surgery/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prostatectomy/methods/*mortality
MH  - Prostatic Neoplasms/*mortality/surgery
MH  - Quebec/epidemiology
EDAT- 2008/03/07 09:00
MHDA- 2008/04/01 09:00
CRDT- 2008/03/07 09:00
PHST- 2008/03/07 09:00 [pubmed]
PHST- 2008/04/01 09:00 [medline]
PHST- 2008/03/07 09:00 [entrez]
AID - BJU7373 [pii]
AID - 10.1111/j.1464-410X.2007.07373.x [doi]
PST - ppublish
SO  - BJU Int. 2008 Apr;101(7):826-32. doi: 10.1111/j.1464-410X.2007.07373.x.