Difference in Incontinence Pad Use between Patients after Radical Prostatectomy and Cancer-Free Population with Subgroup Analysis for Open vs. Minimally Invasive Radical Prostatectomy: A Descriptive Analysis of Insurance Claims-Based Data

PURPOSE

to quantify and compare pre- and post-surgical incontinence pad use between men treated with radical prostatectomy (RP) for prostate cancer (PCa) and cancer-free controls, using population-based Austrian insurance claims data.

METHODS

Men who underwent RP for treating PCa between 2013-2015 were identified. Cancer-free men ≥45 years with and without benign prostate hyperplasia (BPH) were used as controls. Longitudinal data on ICD-diagnoses, type of surgery, prescribed incontinence pads, and hospitals' surgery volumes were aggregated between 2011-2018 to capture pre- and up to three years post-RP follow-up. Monthly rates of pad use were calculated and compared between RP types and cancer-free controls.

RESULTS

A total of 6248 RP patients, 7158 cancer-free men with BPH, and 50,257 cancer-free men without BPH were analyzed. Comparing to pre-RP (0.03, 95%CI: 0.02-0.05), RP resulted in significantly higher rates of prescribed pads (at 3 months: 12.61, 95%CI: 11.59-13.65; 12 months: 6.71, 95%CI: 6.10-7.34; 36 months: 4.91, 95%CI: 3.76-4.62). These rates were also higher than those for cancer free controls (with BPH:0.06, 95%CI: 0.04-0.09; without BPH:0.12, 95%CI: 0.10-0.14). The rate of prescribed pads after surgery continued to decline over time and remained higher among men who underwent minimally invasive RP compared to those who underwent an open procedure.

CONCLUSION

Despite progress in surgical techniques, post-RP incontinence remains a prevalent adverse event. The rate of pad usage steadily improved over the first three years post RP. The rate of patients with incontinence needing pads was higher among those who were treated minimally invasive compared to open approach.

Multidimensional assessment for patients with multimorbidity in primary care – first practice test

Background

Multidimensional geriatric assessments are important for early detection of functional deficits, thus contributing to healthy ageing. According to the Austrian Health Care Structure Plan, such bio-psycho-social assessments should be implemented in primary care and build the basis for the care of patients with chronic diseases. Aim of the present study was to test the feasibility of a respective tool at Austrian general practitioners (GP).

Methods

Overall, 16 GP participated in our practice test and conducted the composed assessment in 185 geriatric patients (39% male, Ø82.6 years, Ø8 diagnoses, 9 medications). Data was analyzed using descriptive statistics (SPSS 26.0).

Results

In 181 tested patients (98%), the assessment revealed at least 1 relevant functional deficit (Ø4, max. 8). Level of care and number of functional deficits correlated (Spearman: 0.3, p < 0.01). Defi-cits were mainly found in mobility (55%: Timed Up and Go-Test >20 sec) and activities of daily liv-ing (86% IADL ≤ 15/16 points and 72% Barthel-Index ≤ 95/100 points). The average time to com-plete and document the functional tests was 34 minutes (min. 14, max. 61, n = 121). Use of the elec-tronic (vs. paper) documentation resulted in a significant lower time requirement of 9 minutes. Re-garding subsequent interventions, 11 GP suggested 121 interventions in 57/185 patients (30.8%); thereby, pharmacological interventions were preferred.

Conclusions

We conclude that our tool tool is practicable in primary care as the required time is manageable. Uncovering functional deficits per se did not induce adequate interventions (neither in number nor in quality); therefore, medical algorithms are needed that make precise recommendations for subse-quent diagnosis and/or treatment/care.

Key messages

Multidimensional assessments are manageable in primary care and reveal functional deficits. Subsequent to the assessment, algorithms are important in order to induce a benefit through inter-ventions.

Epidemiology and Treatment of Patients with Haemophilia in Austria-Update from the Austrian Haemophilia Registry

The Austrian Haemophilia Registry collects epidemiological data on patients with haemophilia, on treatment modalities and potential side effects. The Registry covers more than 85% of the assumed total number of haemophilia patients in Austria. This report summarizes data on 753 patients: 84.3% (635) have haemophilia A and 15.7% (118) have haemophilia B. Patients' median age is 34 years (range: 1-93 years). Of the total cohort, 39.0% (294) patients have severe haemophilia, 11.3% (85) moderate haemophilia, and 49.4% (372) mild haemophilia. Of the patients with severe haemophilia, 38.4% (113) have been infected with hepatitis C virus (HCV) and 12.6% (37) are human immunodeficiency virus (HIV) positive. Overall, 10.6% (67) of patients with haemophilia A and 1.7% (2) of those with haemophilia B have had an inhibitor in their history. Among patients with severe haemophilia, 68.4% (201) receive prophylaxis and 28.6% (84) receive on-demand therapy. There are 65.0% (191) patients with severe haemophilia who are treated with recombinant products. In conclusion, most patients with severe haemophilia receive prophylactic treatment. HCV and HIV infections are still important issues in the Austrian haemophilia population.

The influence of thrombophilia on the long-term survival of patients with a history of venous thromboembolism

Data on the long-term survival following venous thromboembolism (VTE) are rare,and the influence of thrombophilia has not been evaluated thus far. Our aim was to assess thrombophilia-parameters as predictors for long-term survival of patients with VTE. Overall, 1,905 outpatients (99 with antithrombin-, protein C or protein S deficiency, 517 with factor V Leiden, 381 with elevated factor VIII and 160 with elevated homocysteine levels, of these 202 had a combination and 961 had none of these risk factors) were included in the study between September 1, 1994 and December 31, 2007. Retrospective survival analysis showed that a total of 78 patients (4.1%) had died during the analysis period, among those four of definite or possible pulmonary embolism and four of bleeding. In multivariable analysis including age and sex an association with increased mortality was found for hyperhomocysteinemia (hazard ratio 2.0 [1.1.-3.5]) whereas this was not the case for all other investigated parameters. We conclude that the classical hereditary thrombophilia risk factors did not have an impact on the long-term survival of patients with a history of VTE. Thus our study supports the current concept that thrombophilia should not be a determinant for decision on long term anticoagulation. However, hyperhomocysteinaemia, known as a risk factor for recurrent VTE and arterial disease, might impact survival.