Robot-assisted Versus Open Radical Prostatectomy:A Contemporary Analysis of an All-payer Discharge Database
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Robot-assisted Versus Open Radical Prostatectomy:A Contemporary Analysis of an All-payer Discharge Database. / Leow, Jeffrey J; Chang, Steven L; Meyer, Christian P; Wang, Ye; Hanske, Julian; Sammon, Jesse D; Cole, Alexander P; Preston, Mark A; Dasgupta, Prokar; Menon, Mani; Chung, Benjamin I; Trinh, Quoc-Dien.
In: EUR UROL, Vol. 70, No. 5, 11.2016, p. 837-845.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Robot-assisted Versus Open Radical Prostatectomy:A Contemporary Analysis of an All-payer Discharge Database
AU - Leow, Jeffrey J
AU - Chang, Steven L
AU - Meyer, Christian P
AU - Wang, Ye
AU - Hanske, Julian
AU - Sammon, Jesse D
AU - Cole, Alexander P
AU - Preston, Mark A
AU - Dasgupta, Prokar
AU - Menon, Mani
AU - Chung, Benjamin I
AU - Trinh, Quoc-Dien
N1 - Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2016/11
Y1 - 2016/11
N2 - BACKGROUND: More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy.OBJECTIVE: To compare outcomes and costs between RARP and open RP (ORP).DESIGN, SETTING, AND PARTICIPANTS: A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database.INTERVENTION: RARP was ascertained through a review of the hospital charge description master for robotic supplies.OUTCOME MEASURES AND STATISTICAL ANALYSIS: Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates.RESULTS AND LIMITATIONS: RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study.CONCLUSIONS: Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP.PATIENT SUMMARY: In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.
AB - BACKGROUND: More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy.OBJECTIVE: To compare outcomes and costs between RARP and open RP (ORP).DESIGN, SETTING, AND PARTICIPANTS: A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database.INTERVENTION: RARP was ascertained through a review of the hospital charge description master for robotic supplies.OUTCOME MEASURES AND STATISTICAL ANALYSIS: Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates.RESULTS AND LIMITATIONS: RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study.CONCLUSIONS: Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP.PATIENT SUMMARY: In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.
U2 - 10.1016/j.eururo.2016.01.044
DO - 10.1016/j.eururo.2016.01.044
M3 - SCORING: Journal article
C2 - 26874806
VL - 70
SP - 837
EP - 845
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 5
ER -
