Incidence, Risk Factors, and Outcomes for Rectal Injury During Radical Prostatectomy: A Population-based Study

Nimrod S. Barashi, Shane M. Pearce, Andrew J. Cohen, Joseph J Pariser, Vignesh T. Packiam, Scott E. Eggener

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Rectal injury (RI) is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited owing to relatively small cohorts from select, tertiary referral centers. Objective: To evaluate the incidence of and potential risk factors for RI during radical RP at a population level in the USA. Design, settings, and participants: Using the National Inpatient Sample database (2003–2012), we identified patients with prostate cancer who underwent RP. Survey-weighted cohorts were created based on the diagnosis and repair of RI during initial hospitalization. Data included demographics, hospital characteristics, surgical details, complications, and perioperative outcomes. Multivariable logistic regression was used to identify risk factors for RI. Results and limitations: Of 614 294 men who underwent RP, there were 2900 (0.5%) RIs, with a 26% decline from 2003–2006 to 2009–2012 (p < 0.01). Patients with RI were slightly older (62.0 vs 61.2 yr; p < 0.01) and more commonly of African ancestry (0.8% vs 0.4% Caucasians; p < 0.01). RI was more common among patients with benign prostatic hyperplasia (BPH), metastatic disease, and low body mass index (BMI; p < 0.05). The RI incidence was higher for open (0.6%) compared to laparoscopic (0.4%) and robotic RP (0.2%; p < 0.01). RI was more common at rural (0.8% vs 0.5% urban), nonteaching (0.6% vs 0.4% teaching), and low-volume hospitals (0.6% vs 0.3% high-volume; p < 0.01). Complication rates (28% vs 11%; p < 0.01) and length of stay (4.8 vs 2.3 d; p < 0.01) were greater in the RI group. Multivariable analysis identified African ancestry, BPH, and metastatic cancer as predictors of RI, while robotic approach, high-volume hospital, and obesity reduced the risk (p < 0.05). Conclusions: RI during RP is a rare complication, but is more common among men with African ancestry and for procedures carried out using an open surgical technique or in low-volume hospitals, and among those with low BMI, BPH, or metastatic disease. Patient summary: In a large US population, we found that rectal injury (RI) is a rare complication of radical prostatectomy, and that the risk of RI can increase according to patient- and hospital-specific characteristics.

Original languageEnglish (US)
Pages (from-to)501-506
Number of pages6
JournalEuropean Urology Oncology
Volume1
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Prostatectomy
Incidence
Wounds and Injuries
Population
Prostatic Hyperplasia
Low-Volume Hospitals
Robotics
High-Volume Hospitals
Tertiary Care Centers
Inpatients
Length of Stay
Prostatic Neoplasms
Teaching
Hospitalization
Body Mass Index
Obesity
Logistic Models
Demography
Databases

Keywords

  • Intraoperative complications
  • Prostatectomy
  • Prostatic neoplasms
  • Rectal injuries

PubMed: MeSH publication types

  • Journal Article

Cite this

Incidence, Risk Factors, and Outcomes for Rectal Injury During Radical Prostatectomy : A Population-based Study. / Barashi, Nimrod S.; Pearce, Shane M.; Cohen, Andrew J.; Pariser, Joseph J; Packiam, Vignesh T.; Eggener, Scott E.

In: European Urology Oncology, Vol. 1, No. 6, 01.12.2018, p. 501-506.

Research output: Contribution to journalArticle

Barashi, Nimrod S. ; Pearce, Shane M. ; Cohen, Andrew J. ; Pariser, Joseph J ; Packiam, Vignesh T. ; Eggener, Scott E. / Incidence, Risk Factors, and Outcomes for Rectal Injury During Radical Prostatectomy : A Population-based Study. In: European Urology Oncology. 2018 ; Vol. 1, No. 6. pp. 501-506.
@article{86674566f3934f7ca186dfd9328623dc,
title = "Incidence, Risk Factors, and Outcomes for Rectal Injury During Radical Prostatectomy: A Population-based Study",
abstract = "Background: Rectal injury (RI) is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited owing to relatively small cohorts from select, tertiary referral centers. Objective: To evaluate the incidence of and potential risk factors for RI during radical RP at a population level in the USA. Design, settings, and participants: Using the National Inpatient Sample database (2003–2012), we identified patients with prostate cancer who underwent RP. Survey-weighted cohorts were created based on the diagnosis and repair of RI during initial hospitalization. Data included demographics, hospital characteristics, surgical details, complications, and perioperative outcomes. Multivariable logistic regression was used to identify risk factors for RI. Results and limitations: Of 614 294 men who underwent RP, there were 2900 (0.5{\%}) RIs, with a 26{\%} decline from 2003–2006 to 2009–2012 (p < 0.01). Patients with RI were slightly older (62.0 vs 61.2 yr; p < 0.01) and more commonly of African ancestry (0.8{\%} vs 0.4{\%} Caucasians; p < 0.01). RI was more common among patients with benign prostatic hyperplasia (BPH), metastatic disease, and low body mass index (BMI; p < 0.05). The RI incidence was higher for open (0.6{\%}) compared to laparoscopic (0.4{\%}) and robotic RP (0.2{\%}; p < 0.01). RI was more common at rural (0.8{\%} vs 0.5{\%} urban), nonteaching (0.6{\%} vs 0.4{\%} teaching), and low-volume hospitals (0.6{\%} vs 0.3{\%} high-volume; p < 0.01). Complication rates (28{\%} vs 11{\%}; p < 0.01) and length of stay (4.8 vs 2.3 d; p < 0.01) were greater in the RI group. Multivariable analysis identified African ancestry, BPH, and metastatic cancer as predictors of RI, while robotic approach, high-volume hospital, and obesity reduced the risk (p < 0.05). Conclusions: RI during RP is a rare complication, but is more common among men with African ancestry and for procedures carried out using an open surgical technique or in low-volume hospitals, and among those with low BMI, BPH, or metastatic disease. Patient summary: In a large US population, we found that rectal injury (RI) is a rare complication of radical prostatectomy, and that the risk of RI can increase according to patient- and hospital-specific characteristics.",
keywords = "Intraoperative complications, Prostatectomy, Prostatic neoplasms, Rectal injuries",
author = "Barashi, {Nimrod S.} and Pearce, {Shane M.} and Cohen, {Andrew J.} and Pariser, {Joseph J} and Packiam, {Vignesh T.} and Eggener, {Scott E.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.euo.2018.06.001",
language = "English (US)",
volume = "1",
pages = "501--506",
journal = "European urology oncology",
issn = "2588-9311",
publisher = "Elsevier BV",
number = "6",

}

TY - JOUR

T1 - Incidence, Risk Factors, and Outcomes for Rectal Injury During Radical Prostatectomy

T2 - A Population-based Study

AU - Barashi, Nimrod S.

AU - Pearce, Shane M.

AU - Cohen, Andrew J.

AU - Pariser, Joseph J

AU - Packiam, Vignesh T.

AU - Eggener, Scott E.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Rectal injury (RI) is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited owing to relatively small cohorts from select, tertiary referral centers. Objective: To evaluate the incidence of and potential risk factors for RI during radical RP at a population level in the USA. Design, settings, and participants: Using the National Inpatient Sample database (2003–2012), we identified patients with prostate cancer who underwent RP. Survey-weighted cohorts were created based on the diagnosis and repair of RI during initial hospitalization. Data included demographics, hospital characteristics, surgical details, complications, and perioperative outcomes. Multivariable logistic regression was used to identify risk factors for RI. Results and limitations: Of 614 294 men who underwent RP, there were 2900 (0.5%) RIs, with a 26% decline from 2003–2006 to 2009–2012 (p < 0.01). Patients with RI were slightly older (62.0 vs 61.2 yr; p < 0.01) and more commonly of African ancestry (0.8% vs 0.4% Caucasians; p < 0.01). RI was more common among patients with benign prostatic hyperplasia (BPH), metastatic disease, and low body mass index (BMI; p < 0.05). The RI incidence was higher for open (0.6%) compared to laparoscopic (0.4%) and robotic RP (0.2%; p < 0.01). RI was more common at rural (0.8% vs 0.5% urban), nonteaching (0.6% vs 0.4% teaching), and low-volume hospitals (0.6% vs 0.3% high-volume; p < 0.01). Complication rates (28% vs 11%; p < 0.01) and length of stay (4.8 vs 2.3 d; p < 0.01) were greater in the RI group. Multivariable analysis identified African ancestry, BPH, and metastatic cancer as predictors of RI, while robotic approach, high-volume hospital, and obesity reduced the risk (p < 0.05). Conclusions: RI during RP is a rare complication, but is more common among men with African ancestry and for procedures carried out using an open surgical technique or in low-volume hospitals, and among those with low BMI, BPH, or metastatic disease. Patient summary: In a large US population, we found that rectal injury (RI) is a rare complication of radical prostatectomy, and that the risk of RI can increase according to patient- and hospital-specific characteristics.

AB - Background: Rectal injury (RI) is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited owing to relatively small cohorts from select, tertiary referral centers. Objective: To evaluate the incidence of and potential risk factors for RI during radical RP at a population level in the USA. Design, settings, and participants: Using the National Inpatient Sample database (2003–2012), we identified patients with prostate cancer who underwent RP. Survey-weighted cohorts were created based on the diagnosis and repair of RI during initial hospitalization. Data included demographics, hospital characteristics, surgical details, complications, and perioperative outcomes. Multivariable logistic regression was used to identify risk factors for RI. Results and limitations: Of 614 294 men who underwent RP, there were 2900 (0.5%) RIs, with a 26% decline from 2003–2006 to 2009–2012 (p < 0.01). Patients with RI were slightly older (62.0 vs 61.2 yr; p < 0.01) and more commonly of African ancestry (0.8% vs 0.4% Caucasians; p < 0.01). RI was more common among patients with benign prostatic hyperplasia (BPH), metastatic disease, and low body mass index (BMI; p < 0.05). The RI incidence was higher for open (0.6%) compared to laparoscopic (0.4%) and robotic RP (0.2%; p < 0.01). RI was more common at rural (0.8% vs 0.5% urban), nonteaching (0.6% vs 0.4% teaching), and low-volume hospitals (0.6% vs 0.3% high-volume; p < 0.01). Complication rates (28% vs 11%; p < 0.01) and length of stay (4.8 vs 2.3 d; p < 0.01) were greater in the RI group. Multivariable analysis identified African ancestry, BPH, and metastatic cancer as predictors of RI, while robotic approach, high-volume hospital, and obesity reduced the risk (p < 0.05). Conclusions: RI during RP is a rare complication, but is more common among men with African ancestry and for procedures carried out using an open surgical technique or in low-volume hospitals, and among those with low BMI, BPH, or metastatic disease. Patient summary: In a large US population, we found that rectal injury (RI) is a rare complication of radical prostatectomy, and that the risk of RI can increase according to patient- and hospital-specific characteristics.

KW - Intraoperative complications

KW - Prostatectomy

KW - Prostatic neoplasms

KW - Rectal injuries

UR - http://www.scopus.com/inward/record.url?scp=85067203660&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067203660&partnerID=8YFLogxK

U2 - 10.1016/j.euo.2018.06.001

DO - 10.1016/j.euo.2018.06.001

M3 - Article

C2 - 31158094

AN - SCOPUS:85067203660

VL - 1

SP - 501

EP - 506

JO - European urology oncology

JF - European urology oncology

SN - 2588-9311

IS - 6

ER -