151 PERIOPERATIVE OUTCOMES FOR LAPAROSCOPIC AND ROBOTIC PROSTATECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness (II)1 Apr 2013151 PERIOPERATIVE OUTCOMES FOR LAPAROSCOPIC AND ROBOTIC PROSTATECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE Jen-Jane Liu, Bryan Maxwell, Seung Jeon, Perkilis Panousis, John Leppert, and Benjamin Chung Jen-Jane LiuJen-Jane Liu Stanford, CA More articles by this author , Bryan MaxwellBryan Maxwell Stanford, CA More articles by this author , Seung JeonSeung Jeon Seoul, Korea, Democratic People's Republic of More articles by this author , Perkilis PanousisPerkilis Panousis Stanford, CA More articles by this author , John LeppertJohn Leppert Stanford, CA More articles by this author , and Benjamin ChungBenjamin Chung Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1531AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic and robotic prostatectomy have become the dominant approaches for extirpative prostate cancer surgery. We examined contemporary outcomes of laparoscopic or robotic compared to open prostatectomy using a national, prospective perioperative database reflecting diverse practice settings. METHODS The NSQIP database was queried from 2005-2010 for laparoscopic/robotic prostatectomy (CPT 55866) and open retropubic prostatectomy (CPT 55842, 55845). Perioperative outcomes examined were surgical and total operation duration, transfusion rates, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious) and mortality. RESULTS 5,319 radical prostatectomies were identified: 4,036 laparoscopic/robotic (MIS) and 1,283 open. Baseline characteristics including age (62 years), race (82% Caucasian), BMI (30 kg/m2), and American Society of Anesthesia (ASA) status were similar between the two groups. Although operative time was significantly longer in the MIS group, they had significantly fewer perioperative blood transfusions and shorter mean length of stay (table). Major postoperative morbidity and mortality was 5% in the laparoscopic/robotic group and 9% in the open group (p<0.001, table). Age, BMI, presence of medical comorbidities, and open surgical technique were all independently predictive of major complications and death on multivariate analysis. CONCLUSIONS In a nationwide database of diverse medical centers, minimally invasive prostatectomy was associated with longer operative time, but a significantly decreased rate of blood transfusions, length of stay, perioperative complication rate, and mortality compared to open prostatectomy. The open surgical approach was independently associated with significantly more complications on multivariate analysis. Compared to other administrative databases that only capture inpatient complications, NSQIP identifies complications up to 30 days postoperatively, providing a more detailed characterization of post-prostatectomy complications. These data reflect contemporary practice patterns, and suggest that minimally invasive prostatectomy can be performed with low perioperative morbidity. VARIABLE ROBOTIC/LAPAROSCOPIC N = 4,036 (%) OPEN N = 1,283 (%) P-VALUE Surgical time 270 min 252 min < 0.001 Blood transfusion 1.34% 21.4% < 0.0001 Length of stay 1.81 d 3.36 d < 0.0001 COMPLICATION Cardiac (arrest, CVA, MI, death) 15 (0.37%) 14 (1.09%) 0.01 Respiratory (pneumonia, ventilator > 48 h, reintubation) 19 (0.47%) 12 (0.94%) 0.06 DVT/PE 33 (0.82%) 23 (1.79%) 0.003 Composite 201 (4.98%) 116 (9.04%) < 0.0001 Death 2 (0.05%) 5 (0.39%) 0.01 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e62 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jen-Jane Liu Stanford, CA More articles by this author Bryan Maxwell Stanford, CA More articles by this author Seung Jeon Seoul, Korea, Democratic People's Republic of More articles by this author Perkilis Panousis Stanford, CA More articles by this author John Leppert Stanford, CA More articles by this author Benjamin Chung Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...