Adverse in-hospital outcomes in patients with paraplegia who undergo radical prostatectomy

Objective: To test for the association between paraplegia and perioperative complications as well as in-hospital mortality after radical prostatectomy (RP) for non-metastatic prostate cancer. Patients and Methods: We identified patients who underwent RP (National Inpatient Sample [NIS] 2000–2019), stratified according to paraplegia status. The NIS is an inpatient database that rests on data contributed by ~20% of community hospitals within the United States. Descriptive analyses, propensity score matching (PSM, ratio 1:10), and multivariable logistic regression models (LRMs) were used. Results: Of 260 302 patients who underwent RP, there were 223 (0.1%) with paraplegia. The patients with paraplegia who underwent RP were younger (age 60 vs 62 years; P = 0.002) and more frequently had Charlson Comorbidity Index ≥3 (46% vs 2.2%; P < 0.001). After 1:10 PSM, 223/223 (100%) patients with paraplegia and 2230/260 079 (0.9%) without paraplegia who underwent RP were included in further analyses. In multivariable LRMs, patients with paraplegia who underwent RP exhibited significantly higher in-hospital mortality (adjusted odds ratio [aOR] 10.7), higher rates of wound complications (aOR 8.2), infectious complications (aOR 6.2), genitourinary complications (aOR 3.5), intraoperative complications (aOR 2.8), cardiac complications (aOR 2.8), pulmonary complications (aOR 2.6), overall complications (aOR 2.4), blood transfusions (aOR 1.8), and longer length of stay ≥75th percentile (aOR 1.7) (all P ≤ 0.01). Conclusion: Although patients with paraplegia who undergo RP are rare, adverse in-hospital outcomes are substantially more frequent in these individuals. These observations should be carefully considered in clinical decision making and informed consent prior to RP, if such procedure is contemplated in patients with paraplegia.