Further Study of the Increased Mortality Following Transurethral Prostatectomy: A Chart-Based Analysis

TLDR

Large administrative studies have shown higher rates of reoperation and mortality after transurethral prostatectomy compared with open surgery, underscoring the need for a prospective trial to assess relative safety and effectiveness. The study reviewed charts of 485 prostatectomy patients to determine whether unmeasured case‑mix differences explain the higher mortality and reoperation risk after transurethral surgery. The authors abstracted clinical, laboratory, and demographic data from patient charts and built multiple multivariable models to adjust for case‑mix when comparing reoperation and mortality rates between transurethral and open prostatectomy. All adjusted models showed that transurethral prostatectomy was associated with a 1.36–1.89 times higher mortality risk and a 3.62 times higher reoperation risk compared with open surgery.

Abstract

Previous studies using large administrative databases found an elevated relative risk of reoperation and death after transurethral resection of the prostate compared to open prostatectomy. To investigate whether differences in case-mix unmeasured by administrative data explained this finding, we reviewed the charts of 485 patients who had undergone prostatectomy (236 open and 249 transurethral) at the Health Science Centre, Winnipeg, Manitoba, Canada between 1974 and 1980. Data from patient histories, physical examinations and laboratory evaluations were abstracted and used to control for case-mix in models comparing the rates of reoperation and mortality after transurethral versus open prostatectomy. Several models were specified. In all models the relative risk of dying after transurethral prostatectomy remained elevated (1.36 to 1.89), as did the risk for reoperation (3.62). A prospective trial is needed to establish the relative safety and effectiveness of transurethral and open prostatectomy.