An assessment of radical prostatectomy. Time trends, geographic variation, and outcomes. The Prostate Patient Outcomes Research Team.
An assessment of radical prostatectomy. Time trends, geographic variation, and outcomes. The Prostate Patient Outcomes Research Team.
复制标题
DOI：
10.1001/jama.1993.03500200047031
复制
发表时间：
1993-05
期刊：
影响因子：
--
通讯作者：
Grace L. Lu-Yao;D. McLerran;J. Wasson;J. Wennberg;T. Bubolz;Catherine C. Lindsay;B. Littenberg;A. Flood;Chiang-Hua Chang;A. Mulley;M. J. Barry;C. Coley;F. J. Fowler;R. Bruskewitz;P. Albertson;C. Fleming
中科院分区：
文献类型：
--
作者：
Grace L. Lu-Yao;D. McLerran;J. Wasson;J. Wennberg;T. Bubolz;Catherine C. Lindsay;B. Littenberg;A. Flood;Chiang-Hua Chang;A. Mulley;M. J. Barry;C. Coley;F. J. Fowler;R. Bruskewitz;P. Albertson;C. Fleming
目的 研究根治性前列腺切除术率和短期结果的时间趋势和地理差异。设计 1984 年至 1990 年基于人群的根治性前列腺切除术研究。泊松回归用于估计时间和区域效应。设置 50 个州和哥伦比亚特区。参与者 20% 的全国 65 岁或以上男性 Medicare 受益人样本。主要观察指标 前列腺癌根治术率； 30天死亡率；以及根治性前列腺切除术 30 天内的主要心肺并发症、血管并发症或手术修复。结果 总共确定了 10,598 例根治性前列腺切除术。 1990年根治性前列腺切除术的调整率是1984年的5.75倍。各年龄组的相对增幅相似。从 1988 年到 1990 年，比率存在巨大的地理差异：新英格兰和中大西洋地区的所有州的比率等于或低于每 100,000 名男性医疗保险受益人 60 人，而太平洋和山区的所有州的比率等于或高于每 100,000 人 130 人。对于老年男性（75 岁及以上）来说，根治性前列腺切除术后的死亡率和发病率并不小——手术后 30 天内，近 2% 的人死亡，近 8% 的人出现严重心肺并发症。结论 根治性前列腺切除术率的急剧增加和广泛的地理差异使得对该手术的评估成为一个紧迫的问题。 75岁及以上男性的根治性前列腺切除术率上升值得特别关注。
OBJECTIVES To examine temporal trends and geographic variation in radical prostatectomy rates and short-term outcomes. DESIGN Population-based study of radical prostatectomy for the years 1984 through 1990. Poisson regression was used to estimate temporal and regional effects. SETTING The 50 states and the District of Columbia. PARTICIPANTS A 20% national sample of male Medicare beneficiaries aged 65 years or older. MAIN OUTCOME MEASURES Rate of radical prostatectomy; 30-day mortality; and major cardiopulmonary complications, vascular complications, or surgical repairs within 30 days of radical prostatectomy. RESULTS A total of 10,598 radical prostatectomies were identified. The adjusted rate of radical prostatectomy in 1990 was 5.75 times that in 1984. The relative increase was similar in all age groups. Substantial geographic variation existed in rates from 1988 through 1990: all states in the New England and Mid-Atlantic regions had rates equal to or below 60 per 100,000 male Medicare beneficiaries, while all states in the Pacific and Mountain regions had rates equal to or above 130 per 100,000. The mortality and morbidity after radical prostatectomy are not trivial for older men (aged 75 years and older)--almost 2% died and nearly 8% suffered major cardiopulmonary complications within 30 days of the operation. CONCLUSION The sharp increase and wide geographic variation in radical prostatectomy rates make the evaluation of this surgical procedure a pressing issue. The rising rate of radical prostatectomy among men aged 75 years and older merits special attention.