Objective: Radical prostatectomy (RP) may be a treatment option for prostate cancer in patients with chronic kidney disease (CKD). However, the effect of CKD on adverse in‐hospital outcomes after RP is not well known.Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample RP patients between 2005 and 2019. CKD severity was stratified as mild (stage I/II) versus moderate (stage III) versus severe (stage IV/V).Results: Of 191 050 RP patients, 4349 (2.3%) had CKD. Of those, 2301 (52.9%), 1416 (32.6%), and 632 (14.5%) were classified as mild, moderate, or severe CKD, respectively. The CKD rate increased from 0.3% to 5.6% (2005–2019, EAPC: + 15.3%, p < 0.001). CKD patients invariably exhibited higher rates of adverse in‐hospital outcomes, except for in‐hospital mortality. The absolute differences were largest for overall complications (+ 12.5%), length of stay > 2 days (+ 11.8%), and blood transfusions (+ 3.7%, all p < 0.001). CKD was an independent predictor in all comparisons except for in‐hospital mortality (p < 0.05). The detrimental effect was most pronounced for dialysis for acute kidney failure (multivariable odds ratio [OR] 10.49), genitourinary complications (OR: 2.47), and critical care therapies (OR: 2.45, all p < 0.001). Finally, a dose–response relationship of CKD severity (mild vs. moderate vs. severe) and its effect on adverse in‐hospital outcomes was observed in seven of 14 comparisons.Conclusions: CKD patients invariably exhibited higher rates of adverse in‐hospital outcomes after RP. The presence of CKD should be carefully considered when RP represents a management option.

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.

Background/Objectives: Adverse in-hospital outcomes at radical prostatectomy have not been specifically addressed in young patients aged 40–49 years (quadragenarians). Additionally, no comparison between robot-assisted (RARP) vs. open radical prostatectomy (ORP) has been reported in this population. Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic/Poisson regression models addressed quadragenarians undergoing RARP or ORP within the National Inpatient Sample (2009–2019). Results: Of 5426 quadragenarians, 4083 (75.2%) and 1343 (24.8%) underwent RARP and ORP, respectively. The proportion of RARP increased from 68.1 to 84.5% (2009–2019, EAPC: +2.8%, p < 0.001). Adverse in-hospital outcomes after RARP were invariably lower than those after ORP. Specifically, the rates of overall complications (7.8 vs. 13.4%, Δ −5.6%, multivariable odds ratio (OR): 0.54), blood transfusions (1.2 vs. 6.3%, Δ −5.1%, OR: 0.21), and length of stay (LOS) > 2 days (10.6 vs. 28.7%, Δ −18.1%, OR: 0.32) were lower after RARP than after ORP (all p < 0.001). After additional one-to-one PSM between ORP and RARP patients, virtually the same results were reported (overall complications: 7.0 vs. 13.4%, Δ −6.4%, OR: 0.49; blood transfusion rates: 1.5 vs. 6.3%, Δ −4.8%, OR: 0.23; LOS > 2 days: 10.9 vs. 28.7%, Δ −17.8%, OR: 0.30). Conversely, RARP use resulted in higher total hospital charges (USD 43,690 vs. 36,840, Δ USD +6850, IRR: 1.18; p < 0.001). Conclusions: Quadragenarians exhibited a more favorable adverse in-hospital outcome profile after RARP vs. ORP. These advantages are offset by a small, albeit significant, increase in total hospital charges.