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30-day mortality and major complications after radical prostatectomy: influence of age and comorbidity.

https://arctichealth.org/en/permalink/ahliterature172378
Source
J Natl Cancer Inst. 2005 Oct 19;97(20):1525-32
Publication Type
Article
Date
Oct-19-2005
Author
Shabbir M H Alibhai
Marc Leach
George Tomlinson
Murray D Krahn
Neil Fleshner
Eric Holowaty
Gary Naglie
Author Affiliation
Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada. shabbir.alibhai@uhn.on.ca
Source
J Natl Cancer Inst. 2005 Oct 19;97(20):1525-32
Date
Oct-19-2005
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Cohort Studies
Comorbidity
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Ontario - epidemiology
Prostatectomy - adverse effects - methods - mortality
Prostatic Neoplasms - mortality - surgery
Registries
Retrospective Studies
Risk assessment
Risk factors
Abstract
Radical prostatectomy is associated with excellent long-term disease control for localized prostate cancer. Prior studies have suggested an increased risk of short-term complications among older men who underwent radical prostatectomy, but these studies did not adjust for comorbidity.
We examined mortality and complications occurring within 30 days following radical prostatectomy among all 11,010 men who underwent this surgery in Ontario, Canada, between 1990 and 1999 using multivariable logistic regression modeling. We adjusted for comorbidity using two common comorbidity indices. Statistical tests were two-sided.
Overall, 53 men (0.5%) died, and 2195 [corrected] (19.9%[corrected]) had one or more complications within 30 days of radical prostatectomy. In models adjusted for comorbidity and year of surgery, age was associated with an increased risk of 30-day mortality (odds ratio = 2.04 per decade of age, 95% confidence interval [CI] = 1.23 to 3.39). However, the absolute 30-day mortality risk was low, even in older men, at 0.66% (95% CI = 0.2 to 1.1%) for men aged 70-79 years. In adjusted models, age was associated with an increased risk of cardiac (Ptrend
Notes
Comment In: J Natl Cancer Inst. 2006 Mar 15;98(6):421; author reply 421-216537836
Erratum In: J Natl Cancer Inst. 2007 Nov 7;99(21):1648
PubMed ID
16234566 View in PubMed
Less detail

Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?

https://arctichealth.org/en/permalink/ahliterature135721
Source
BJU Int. 2011 Nov;108(10):1588-96
Publication Type
Article
Date
Nov-2011
Author
Murray Krahn
Karen E Bremner
George Tomlinson
Jin Luo
Paul Ritvo
Gary Naglie
Shabbir M H Alibhai
Author Affiliation
Toronto General Research Institute, Canada.
Source
BJU Int. 2011 Nov;108(10):1588-96
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Androgen Antagonists - therapeutic use
Chemotherapy, Adjuvant - utilization
Gonadotropin-Releasing Hormone - antagonists & inhibitors
Humans
Male
Neoplasm Recurrence, Local - drug therapy
Ontario - epidemiology
Orchiectomy - statistics & numerical data
Prevalence
Prostatectomy - statistics & numerical data
Prostatic Neoplasms - drug therapy - epidemiology - surgery
Time Factors
Abstract
To describe patterns of initiation of androgen deprivation therapy (ADT) in a population-based cohort of patients with prostate cancer.
All patients with prostate cancer in Ontario, Canada, who started =90 days of ADT at age =66 years in 1995-2005 were classified by ADT regimen: medical castration [oestrogen and/or luteinizing hormone-releasing hormone (LHRH) agonist); orchidectomy; antiandrogen monotherapy; combined androgen blockade (CAB) medical (medical castration plus antiandrogen); CAB surgical (orchidectomy plus antiandrogen). Indications for ADT were as follows: neoadjuvant (short-term before prostatectomy or radiation therapy); adjuvant (long-term with prostatectomy or radiation therapy); metastatic disease; biochemical recurrence; primary (localized disease); other. We examined trends in ADT regimen and indication over time.
The number of patients initiating ADT increased from 1995 to 2001 (2106-2916 per year) and declined thereafter to 2200-2300 annually (total n= 26,809). However, prostate cancer prevalence doubled over these years, and the rate of ADT initiation decreased from 16 to 7 per 100 person-years. Patterns varied by regimen and indication. Medical castration increased from 12% of all ADT in 1995 to 47% in 2005; orchidectomy decreased from 17 to 4%. Use for metastatic disease remained stable, but adjuvant therapy increased from
PubMed ID
21453344 View in PubMed
Less detail

Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: a nested substudy of the MAP.3 randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature127170
Source
Lancet Oncol. 2012 Mar;13(3):275-84
Publication Type
Article
Date
Mar-2012
Author
Angela M Cheung
Lianne Tile
Savannah Cardew
Sandhya Pruthi
John Robbins
George Tomlinson
Moira K Kapral
Sundeep Khosla
Sharmila Majumdar
Marta Erlandson
Judy Scher
Hanxian Hu
Alice Demaras
Lavina Lickley
Louise Bordeleau
Christine Elser
James Ingle
Harriet Richardson
Paul E Goss
Author Affiliation
University Health Network, University of Toronto, Toronto, ON, Canada. angela.cheung@uhn.ca
Source
Lancet Oncol. 2012 Mar;13(3):275-84
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Androstadienes - adverse effects
Anticarcinogenic Agents - adverse effects
Aromatase Inhibitors - adverse effects
Bone Density - drug effects
Bone and Bones - drug effects - radiography
Breast Neoplasms - prevention & control
Calcium - administration & dosage
Canada
Chi-Square Distribution
Dietary Supplements
Double-Blind Method
Female
Femur Neck - drug effects - radiography
Hip Joint - drug effects - radiography
Humans
Lumbar Vertebrae - drug effects - radiography
Middle Aged
Osteoporosis - chemically induced - radiography
Patient Selection
Placebos
Postmenopause
Primary prevention - methods
Risk assessment
Risk factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
United States
Vitamin D - administration & dosage
Abstract
Exemestane can prevent breast cancer in postmenopausal women. Because of potential widespread use, we examined the safety of exemestane on bone health.
In this nested safety substudy of the MAP.3 trial (a randomised, placebo-controlled, double-blind trial of exemestane 25 mg a day for the primary prevention of breast cancer), we included postmenopausal women from five centres who were eligible to participate in MAP.3, not osteoporotic, not receiving drugs for bone-related disorders, with baseline lumbar spine, total hip, and femoral neck T-scores above -2·0. The primary endpoint was percent change from baseline to 2 years in total volumetric bone mineral density (BMD) at the distal radius by high-resolution peripheral quantitative CT. The primary analysis was per protocol using a non-inferiority margin. This analysis was done earlier than originally planned because of the impending announcement of MAP.3 results and subsequent unmasking of patients to treatment assignment. This study is registered with ClinicalTrials.gov, number NCT01144468, and has been extended to 5 years of unmasked follow-up.
351 women (176 given exemestane, 175 given placebo; median age 61·3 years [IQR 59·2-64·9]) met our inclusion criteria and completed baseline assessment. At the time of clinical cutoff, 242 women had completed 2-year follow-up (124 given exemestane, 118 given placebo). From baseline to 2 years, the mean percent change in total volumetric BMD at the distal radius was -6·1% (95% CI -7·0 to -5·2) in the exemestane group and -1·8% (-2·4 to -1·2) in the placebo group (difference -4·3%, 95% CI -5·3 to -3·2; p
Notes
Comment In: Lancet Oncol. 2012 Mar;13(3):221-222318094
PubMed ID
22318095 View in PubMed
Less detail

Continued undertreatment of older men with localized prostate cancer.

https://arctichealth.org/en/permalink/ahliterature182771
Source
Urology. 2003 Nov;62(5):860-5
Publication Type
Article
Date
Nov-2003
Author
Kevin L Schwartz
Shabbir M H Alibhai
George Tomlinson
Gary Naglie
Murray D Krahn
Author Affiliation
University of Toronto, School of Medicine, Toronto, Ontario, Canada.
Source
Urology. 2003 Nov;62(5):860-5
Date
Nov-2003
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - epidemiology - pathology - therapy
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Humans
Life expectancy
Male
Ontario - epidemiology
Prostatic Neoplasms - epidemiology - pathology - therapy
Quality-Adjusted Life Years
Refusal to Treat - statistics & numerical data
Sampling Studies
Abstract
To explore the association among patient factors (age, comorbidity), disease-specific factors (stage, Gleason score), and suboptimal initial treatment in a cohort of men with localized prostate cancer.
An age-stratified, geographically representative cohort of 276 patients with localized prostate cancer diagnosed in 1995 to 1996 was identified using the Ontario Cancer Registry. Data describing age, comorbidity, Gleason score, stage, and treatment received were abstracted by chart review. A previously developed Markov state-transition model was used to estimate the optimal treatment for each patient. A logistic regression model was developed to estimate the predictors of suboptimal treatment. The treatment received was compared with the predicted optimal treatment. Suboptimal treatment occurred when the difference between the optimal treatment and treatment received was clinically important (thresholds of 0.2 to 1.0 life year or quality-adjusted life year).
Of 276 patients, 41 (14.9%) received suboptimal treatment. Age, Gleason score, and comorbidity were independent predictors of suboptimal treatment. Healthy men aged 70 years or older, with Gleason scores of 5 to 7 or 8 to 10 had the greatest proportion of suboptimal treatment (46.9% and 72.7%, respectively). The average quality-adjusted life expectancy lost for healthy men aged 70 to 79 years with Gleason scores of 5 to 7 and 8 to 10 was 0.62 year and 0.93 year per patient, respectively.
Otherwise healthy men in their 70s and 80s with localized prostate cancer are often receiving watchful waiting and potentially losing valuable years of life. Many of these patients with at least moderate-grade disease may benefit from potentially curative therapy (radical prostatectomy or radiotherapy).
PubMed ID
14624909 View in PubMed
Less detail

Cumulative patency of contemporary fistulas versus grafts (2000-2010).

https://arctichealth.org/en/permalink/ahliterature116697
Source
Clin J Am Soc Nephrol. 2013 May;8(5):810-8
Publication Type
Article
Date
May-2013
Author
Charmaine E Lok
Jessica M Sontrop
George Tomlinson
Dheeraj Rajan
Mark Cattral
George Oreopoulos
Jeremy Harris
Louise Moist
Author Affiliation
Division of Nephrology, Department of Medicine, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada. charmaine.lok@uhn.ca
Source
Clin J Am Soc Nephrol. 2013 May;8(5):810-8
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Angioplasty
Arteriovenous Shunt, Surgical - adverse effects - methods
Blood Vessel Prosthesis Implantation - adverse effects
Female
Graft Occlusion, Vascular - etiology - physiopathology - therapy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Ontario
Renal Dialysis
Retrospective Studies
Risk factors
Thrombolytic Therapy
Time Factors
Treatment Outcome
Upper Extremity - blood supply
Vascular Patency
Young Adult
Abstract
Comparisons of fistulas and grafts often overlook the high primary failure rate of fistulas. This study compared cumulative patency (time from access creation to permanent failure) of fistulas and grafts.
Vascular accesses of 1140 hemodialysis patients from two centers (Toronto and London, Ontario, Canada, 2000-2010) were analyzed. Cumulative patency was compared between groups using Kaplan-Meier survival curves and log-rank tests. Hazard ratios (HRs) for fistula failure relative to grafts and 95% confidence intervals (95% CIs) are reported.
There were 1012 (88.8%) fistulas and 128 (11.2%) grafts. The primary failure rate was two times greater for fistulas than for grafts: 40% versus 19% (P
Notes
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Comment In: Clin J Am Soc Nephrol. 2013 May;8(5):708-1023599407
PubMed ID
23371955 View in PubMed
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Early management of newly diagnosed rheumatoid arthritis by Canadian rheumatologists: a national, multicenter, retrospective cohort.

https://arctichealth.org/en/permalink/ahliterature131696
Source
J Rheumatol. 2011 Nov;38(11):2342-5
Publication Type
Article
Date
Nov-2011
Author
Ruben Tavares
Janet E Pope
Jean-Luc Tremblay
Carter Thorne
Vivian P Bykerk
Juris Lazovskis
Kenneth L N Blocka
Mary J Bell
Diane Lacaille
Carol A Hitchon
Avril A Fitzgerald
Wesley K Fidler
Arthur A M Bookman
James M Henderson
Dianne P Mosher
Dalton E Sholter
Majed Khraishi
Boulos Haraoui
Hong Chen
Xiuying Li
Andreas Laupacis
Gilles Boire
George Tomlinson
Claire Bombardier
Author Affiliation
McMaster University, Hamilton, Canada. ruben.tavares@sympatico.ca
Source
J Rheumatol. 2011 Nov;38(11):2342-5
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Antirheumatic Agents - therapeutic use
Canada - epidemiology
Cohort Studies
Disability Evaluation
Disease Management
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Physician's Practice Patterns
Retrospective Studies
Rheumatic Fever - diagnosis - drug therapy - epidemiology
Severity of Illness Index
Treatment Outcome
Abstract
To describe early rheumatologic management for newly diagnosed rheumatoid arthritis (RA) in Canada.
A retrospective cohort of 339 randomly selected patients with RA diagnosed from 2001-2003 from 18 rheumatology practices was audited between 2005-2007.
The most frequent initial disease-modifying antirheumatic drugs (DMARD) included hydroxychloroquine (55.5%) and methotrexate (40.1%). Initial therapy with multiple DMARD (15.6%) or single DMARD and corticosteroid combinations (30.7%) was infrequent. Formal assessment measures were noted infrequently, including the Health Assessment Questionnaire (34.6%) and Disease Activity Score for 28 joints (8.9%).
Initial pharmacotherapy is consistent with guidelines from the period. The infrequent reporting of multiple DMARD combinations and formal assessment measures has implications for current clinical management and warrants contemporary reassessment.
Notes
Comment In: J Rheumatol. 2011 Nov;38(11):2287-922045932
PubMed ID
21885485 View in PubMed
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The effect of English language proficiency on length of stay and in-hospital mortality.

https://arctichealth.org/en/permalink/ahliterature181208
Source
J Gen Intern Med. 2004 Mar;19(3):221-8
Publication Type
Article
Date
Mar-2004
Author
Ava John-Baptiste
Gary Naglie
George Tomlinson
Shabbir M H Alibhai
Edward Etchells
Angela Cheung
Moira Kapral
Wayne L Gold
Howard Abrams
Maria Bacchus
Murray Krahn
Author Affiliation
Division of General Internal Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Source
J Gen Intern Med. 2004 Mar;19(3):221-8
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Aged
Canada
Communication
Communication Barriers
Female
Hospital Mortality
Humans
Language
Length of Stay - statistics & numerical data
Male
Odds Ratio
Patient Admission - statistics & numerical data
Retrospective Studies
Abstract
In ambulatory care settings, patients with limited English proficiency receive lower quality of care. Limited information is available describing outcomes for inpatients.
To investigate the effect of English proficiency on length of stay (LOS) and in-hospital mortality.
Retrospective analysis of administrative data at 3 tertiary care teaching hospitals (University Health Network) in Toronto, Canada.
Consecutive inpatient admissions from April 1993 to December 1999 were analyzed for LOS differences first by looking at 23 medical and surgical conditions (59,547 records) and then by a meta-analysis of 220 case mix groups (189,119 records). We performed a similar analysis for in-hospital mortality.
LOS and odds of in-hospital death for limited English-proficient (LEP) patients relative to English-proficient (EP) patients.
LEP patients stayed in hospital longer for 7 of 23 conditions (unstable coronary syndromes and chest pain, coronary artery bypass grafting, stroke, craniotomy procedures, diabetes mellitus, major intestinal and rectal procedures, and elective hip replacement), with LOS differences ranging from approximately 0.7 to 4.3 days. A meta-analysis using all admission data demonstrated that LEP patients stayed 6% (approximately 0.5 days) longer overall than EP patients (95% confidence interval, 0.04 to 0.07). LEP patients were not at increased risk of in-hospital death (relative odds, 1.0; 95% confidence interval, 0.9 to 1.1).
Patients with limited English proficiency have longer hospital stays for some medical and surgical conditions. Limited English proficiency does not affect in-hospital mortality. The effect of communication barriers on outcomes of care in the inpatient setting requires further exploration, particularly for selected conditions in which length of stay is significantly prolonged.
Notes
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PubMed ID
15009776 View in PubMed
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The effect of regionalization on outcome in pulmonary lobectomy: a Canadian national study.

https://arctichealth.org/en/permalink/ahliterature140705
Source
J Thorac Cardiovasc Surg. 2010 Oct;140(4):757-63
Publication Type
Article
Date
Oct-2010
Author
Christian J Finley
Anna Bendzsak
George Tomlinson
Shaf Keshavjee
David R Urbach
Gail E Darling
Author Affiliation
Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada. christian.finley@uhn.on.ca
Source
J Thorac Cardiovasc Surg. 2010 Oct;140(4):757-63
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Cluster analysis
Cross-Sectional Studies
Databases as Topic
Delivery of Health Care - organization & administration - statistics & numerical data
Female
Hospital Mortality
Hospitals - statistics & numerical data
Humans
Length of Stay
Linear Models
Logistic Models
Male
Middle Aged
Odds Ratio
Organizational Objectives
Outcome and Process Assessment (Health Care) - statistics & numerical data
Pneumonectomy - adverse effects - mortality
Program Evaluation
Quality of Health Care - statistics & numerical data
Regional Health Planning - organization & administration - statistics & numerical data
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Young Adult
Abstract
To examine the effect of regionalization of thoracic surgery services in Canada by evaluating change over time in hospital volumes of pulmonary lobectomy and its impact on length of stay and in-hospital mortality.
Data on pulmonary lobectomy between 1999 and 2007 were abstracted from the Canadian Institute for Health Information Discharge Abstract Database. In-hospital mortality was analyzed by logistic regression, and log-transformed length of stay was analyzed by linear regression. Cross-sectional analysis of hospital volume, in-hospital mortality, and length of stay was performed, controlling for clustering. Within-hospital changes in annual volume on outcome was analyzed using multivariable logistic regression, controlling for Charlson comorbidity index and other confounders.
Of 19,732 patients, 10, 281 (52%) were male, with an average age of 63.3 years. There was a 45% (95% confidence interval, 21-61; P = .001) relative risk reduction in in-hospital mortality with a 19% reduction in length of stay (95% confidence interval, 12-25; P
PubMed ID
20850656 View in PubMed
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The epidemiology of rheumatoid arthritis in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature104423
Source
Arthritis Rheumatol. 2014 Apr;66(4):786-93
Publication Type
Article
Date
Apr-2014
Author
Jessica Widdifield
J Michael Paterson
Sasha Bernatsky
Karen Tu
George Tomlinson
Bindee Kuriya
J Carter Thorne
Claire Bombardier
Author Affiliation
University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Source
Arthritis Rheumatol. 2014 Apr;66(4):786-93
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - epidemiology
Databases, Factual
Female
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Prevalence
Abstract
Epidemiologic assessments of sufficiently large populations are required in order to obtain robust estimates of disease prevalence and incidence, particularly when exploring the influence of various factors (age, sex, calendar time). We undertook this study to describe the epidemiology of rheumatoid arthritis (RA) over the past 15 years.
We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based research database of all Ontarians with RA. The ORAD records were linked with census data to calculate crude and age and sex-standardized prevalence and incidence rates from 1996 to 2010. Vital statistics were used to estimate annual all-cause mortality during the study period.
As of 2010, there were 97,499 Ontarians with RA, corresponding to a cumulative prevalence of 0.9%. Age and sex-standardized RA prevalence increased steadily over time from 473 (95% confidence interval [95% CI] 469-478) per 100,000 population (0.49%) in 1996 to 784 (95% CI 779-789) per 100,000 population (0.9%) in 2010. Age and sex-standardized incidence per 100,000 population ranged from 62 (95% CI 60-63) in 1996 to 54 (95% CI 52-55) in 2010. All-cause mortality decreased by a relative 21.4% since 1996.
Over a 15-year period, we observed an increase in RA prevalence over time. This rise may be attributed to the increasing time to ascertain cases (which may have been latent in the population during earlier years of the study), increasing survival, and/or an increase in the aging background population. Incidence appears to be stable.
PubMed ID
24757131 View in PubMed
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Examining the location and cause of death within 30 days of radical prostatectomy.

https://arctichealth.org/en/permalink/ahliterature176227
Source
BJU Int. 2005 Mar;95(4):541-4
Publication Type
Article
Date
Mar-2005
Author
Shabbir M H Alibhai
Marc Leach
George Tomlinson
Author Affiliation
Division of General Internal Medicine & Clinical Epidemiology, University Health Network, University of Toronto, Canada. shabbir.alibhai@uhn.on.ca
Source
BJU Int. 2005 Mar;95(4):541-4
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiovascular Diseases - mortality
Cause of Death
Cerebrovascular Disorders - mortality
Gastrointestinal Hemorrhage - mortality
Humans
Male
Middle Aged
Ontario - epidemiology
Postoperative Complications - mortality
Prostatectomy - mortality
Prostatic Neoplasms - surgery
Risk factors
Time Factors
Abstract
To better characterize the cause and location of death after radical prostatectomy (RP), as early mortality is relatively uncommon after RP, with little known about the cause of death among men who die within 30 days of RP, and the trend toward earlier discharge after surgery means that a greater proportion of early mortality after RP may occur out of hospital.
Using the Ontario Cancer Registry, we identified 11,010 men (mean age 68 years) who had a RP in the province of Ontario between 1990 and 1999. We identified the occurrence and location of all deaths within 30 days of RP. The cause of death was obtained from death certificate information. Logistic regression was used to examine factors (age, comorbidity, year of surgery) associated with the location of death.
Of the 11,010 men, 53 died within 30 days of RP (0.5%); of these 53 men, 28 (53%) died in hospital. Neither age, comorbidity nor year of surgery were significantly associated with location of death (P > 0.05). Major causes of death included cardiovascular disease (38%) and pulmonary embolism (13%). More than half of the patients who died out of hospital had an unknown cause of death.
Almost half of all deaths within 30 days of RP occur out of hospital; the two most common causes of death are potentially preventable. More detailed cause-of-death information may help to identify opportunities for prevention.
Notes
Comment In: BJU Int. 2005 Jun;95(9):136915892837
PubMed ID
15705076 View in PubMed
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