This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

John Concato, MD, MS, MPH; Ralph I. Horwitz, MD; Alvan R. Feinstein, MD, MS; Joann G. Elmore, MD; Stephen F. Schiff, MD

JAMA. 1992;267(8):1077-1082.

Abstract
Objective.
—In recent studies of patients with benign prostatic hyperplasia (BPH), men undergoing transurethral resection of the prostate (TURP) had higher long-term mortality than men undergoing open prostatectomy. We tested the hypothesis that the higher mortality for patients undergoing TURP could have occurred if these patients were older and sicker at the time of surgery than patients undergoing open prostatectomy.

Design and Setting.
—Retrospective cohort study at Yale—New Haven (Conn) Hospital.

Patients.
—Two hundred fifty-two men who underwent TURP or open prostatectomy from 1979 through 1981 for the treatment of BPH.

Main Outcome Measures.
—Five-year mortality adjusted for age and severity of comorbid illness at the time of surgery.

Results.
—The crude 5-year mortality rates were 17.5% (22 of 126 patients) for the TURP group and 13.5% (17 of 126 patients) for the open group. At the time of surgery, however, patients in the TURP group were sicker and older than patients in the open group. As the detail and quality of the assessment of comorbidity increased, the adjusted risk of TURP decreased. Improved classifications of comorbidity in three different forms of statistical analysis did not show an effect of type of prostatectomy on long-term mortality (Mantel-Haenszel relative risk, 1.03; 95% confidence interval, 0.57 to 1.87).

Conclusions.
—These results suggest that TURP does not increase long-term mortality after surgery for the treatment of BPH. Inadequate accounting for severity of illness may also affect other statistical "adjustments" used in research concerned with patient outcomes.

(JAMA. 1992;267:1077-1082)

Author Affiliations
From the Departments of Medicine and Epidemiology and Public Health (Drs Concato, Horwitz, Feinstein, and Elmore) and Urology (Dr Schiff), Yale University School of Medicine, New Haven, Conn. Dr Concato is now with the Department of Medicine, New York (NY) University School of Medicine.

Footnotes
Presented at the National Meeting of the American Association of Physicians, American Society for Clinical Investigation, and American Federation for Clinical Research, Washington, DC, May 5, 1990.

Drs Concato and Elmore were postdoctoral fellows in the Robert Wood Johnson Clinical Scholars Program. Dr Concato was supported by the Veterans Administration. This research partially fulfilled the requirement for a thesis for the MPH degree.

Reprint requests to New York University School of Medicine, 550 First Ave, New York, NY 10016 (Dr Concato).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Evaluation of the clinimetric properties of the Early Inflammatory Arthritis--self-administered comorbidity questionnaire
Baron et al.
Rheumatology (Oxford) 2009;48:390-394.
ABSTRACT | FULL TEXT  

Administrative data outperformed single-day chart review for comorbidity measure
Luthi et al.
Int J Qual Health Care 2007;19:225-231.
ABSTRACT | FULL TEXT  

Anemia and Outcomes in Patients With Heart Failure: A Study From the National Heart Care Project
Kosiborod et al.
Arch Intern Med 2005;165:2237-2244.
ABSTRACT | FULL TEXT  

30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity
Alibhai et al.
JNCI J Natl Cancer Inst 2005;97:1525-1532.
ABSTRACT | FULL TEXT  

Exploring the impact of Acute Pain Teams (APTs) on patient outcomes using routine data: Can it be done?
McDonnell et al.
Journal of Research in Nursing 2005;10:383-402.
ABSTRACT  

Comorbidity Considerations in Geriatric Oncology Research
Yates
CA Cancer J Clin 2001;51:329-336.
ABSTRACT | FULL TEXT  

Use of comorbidity scores for control of confounding in studies using administrative databases
Schneeweiss and Maclure
Int J Epidemiol 2000;29:891-898.
ABSTRACT | FULL TEXT  

Variation in the Use of Laparoscopic Cholecystectomy for Elderly Patients With Acute Cholecystitis
Laycock et al.
Arch Surg 2000;135:457-462.
ABSTRACT | FULL TEXT  

Prognostic Staging System for Recurrent, Persistent, and Second Primary Cancers of the Oral Cavity and Oropharynx
Yueh et al.
Arch Otolaryngol Head Neck Surg 1998;124:975-981.
ABSTRACT | FULL TEXT  

Users' Guides to the Medical Literature: X. How to Use an Article Reporting Variations in the Outcomes of Health Services
Naylor et al.
JAMA 1996;275:554-558.
ABSTRACT  

The Effect of Age and Comorbidity in the Treatment of Elderly Women With Nonmetastatic Breast Cancer
Newschaffer et al.
Arch Intern Med 1996;156:85-90.
ABSTRACT  

Pitfalls in Nonrandomized Outcomes Studies: The Case of Incidental Appendectomy With Open Cholecystectomy
Wen et al.
JAMA 1995;274:1687-1691.
ABSTRACT  

Long-term Survival Among Men With Conservatively Treated Localized Prostate Cancer
Albertsen et al.
JAMA 1995;274:626-631.
ABSTRACT  

Sex Differences in the Management of Patients Hospitalized With Ischemic Cerebrovascular Disease
Patrick et al.
Stroke 1995;26:577-580.
ABSTRACT | FULL TEXT  

Demographic Portrayal and Outcome Analysis of Head and Neck Cancer Surgery in the Elderly
McGuirt and Davis
Arch Otolaryngol Head Neck Surg 1995;121:150-154.
ABSTRACT  

Comparing healthcare outcomes
Orchard
BMJ 1994;308:1493-1496.
FULL TEXT  

Racial Differences in the Use of Invasive Cardiovascular Procedures in the Department of Veterans Affairs Medical System
Whittle et al.
NEJM 1993;329:621-627.
ABSTRACT | FULL TEXT  

Therapies for Benign Prostatic Hyperplasia
Concato et al.
JAMA 1993;269:867-867.
ABSTRACT  

Therapies for Benign Prostatic Hyperplasia
Mebust
JAMA 1992;268:1269-1269.
ABSTRACT  

Therapies for Benign Prostatic Hyperplasia
Roos et al.
JAMA 1992;268:1269-1270.
ABSTRACT