© The Author 2006. Published by Oxford University Press.
CORRESPONDENCE |
RESPONSE: Re: 30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity
Affiliations of authors: Department of Medicine, University Health Network (SMHA, ML, GAT, MDK); Geriatric Program, Toronto Rehabilitation Institute, Toronto, Canada (SMHA, GN)
Correspondence to: Shabbir M. H. Alibhai, MD, MSc, University Health Network Medicine, 200 Elizabeth Street, Room EN 14–214, Toronto, Ontario M5G 2C4, Canada (e-mail: shabbir.alibhai{at}uhn.on.ca).
We thank Russo et al. for sharing the results of their analysis of 30-day mortality among more than 4000 men who underwent radical prostatectomy in Milan, Italy, during a 10-year period. Similar to our findings that were recently reported in the Journal, the authors found an increased risk of 30-day mortality with increasing age (odds ratio [OR] = 2.7). This estimate is similar to both our unadjusted (OR = 2.5, 95% confidence interval [CI] = 1.5 to 4.2) and adjusted (OR = 2.0, 95% CI = 1.2 to 3.4) risk estimates. We do not know whether the odds ratio reported for age by Russo et al. was unadjusted or adjusted.
Both our analysis and the data reported by Russo et al. suggest that cardiovascular disease (including coronary artery disease and congestive heart failure in our model and congestive heart failure only in the analysis by Russo et al.) is associated with 30-day mortality. Russo et al. do not report if they considered coronary artery disease separately. The wide confidence intervals around some of the estimates associated with comorbidity reported by Russo et al. suggest that few patients who underwent surgery had the conditions in question.
Although the possible associations between age, comorbidity, and income reported by Russo et al. are intriguing, the very small number of deaths that occurred (n = 17) severely constrains any multivariable modelling approaches. Indeed, in Russo et al.'s analysis, the association between income and mortality was not statistically significant. In our own dataset, because of privacy and confidentiality issues, we did not have access to income measures, so we are unable to confirm or refute these associations. The preliminary findings of Russo et al. therefore need replication in larger datasets. If the income-mortality association is true, the next step would be to understand the mechanism(s) by which income might impact early surgical mortality.
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J Natl Cancer Inst 2006 98: 421.
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