Perioperative Complications and In-Hospital Mortality After Radical Prostatectomy in Prostate Cancer Patients with a History of Heart Valve Replacement.

Overview

abstract

Objective: To test for in-hospital mortality and complication rates in a population-based group of patients with vs. without a history of heart valve replacement undergoing radical prostatectomy (RP). Methods: Relying on the National Inpatient Sample (2000-2019), prostate cancer patients undergoing RP were stratified according to the presence or absence of heart-valve replacement. Multivariable logistics and Poisson regression models addressed adverse hospital outcomes. Results: Within the NIS, 220,358 patients underwent RP. Of those, 694 (0.3%) had a history of heart valve replacement. The patients undergoing heart valve replacement were older (median age 66 vs. 62 years). The proportion of patients with a history of heart valve replacement increases with the Charlson Comorbidity Index (CCI): CCI 0-0.3%, CCI 1-0.4%, and CCI ≥ 2-0.7%. Patients with a history of heart valve replacement exhibited higher rates of postoperative bleeding (<1.5% vs. <0.1%; odds ratio (OR) 16.2; p < 0.001), cardiac complications (7.5% vs. 1.2%; OR 3.9; p < 0.001), infections (<1.5% vs. 0.1%; OR 3.7; p = 0.01), critical care therapy (CCT) use (<1.5% vs. 0.4%; OR 2.5; p = 0.003), intraoperative complications (8.8% vs. 4.1%; OR 1.9; p < 0.001), transfusions (11% vs. 7.2%; OR 1.5; p < 0.001), longer hospital stay (mean 3.39 vs. 2.37 days; rates ratio [RR] 1.4; p < 0.001), and higher estimated hospital cost (median 33,539 vs. 30,716 $USD; RR 1.1; p < 0.001). Conversely, no statistically significant differences were observed in vascular complications (p = 0.3) or concerning in-hospital mortality (p = 0.1). Conclusions: After RP, patients with a history of heart valve replacement exhibited a higher rate of eight out of nine adverse in-hospital outcomes. However, these differences did not translate into higher in-hospital mortality.