844 COMPARATIVE ANALYSIS OF COMPLICATIONS IN OPEN VERSUS MINIMALLY INVASIVE RETROPERITONEAL LYMPH NODE DISSECTION IN A NATIONAL COHORT

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy - Malignant Disease1 Apr 2012844 COMPARATIVE ANALYSIS OF COMPLICATIONS IN OPEN VERSUS MINIMALLY INVASIVE RETROPERITONEAL LYMPH NODE DISSECTION IN A NATIONAL COHORT Seth A. Cohen, Kerrin L. Palazzi, Wassim M. Bazzi, J. Kellogg Parsons, Sean P. Stroup, Samuel K. Park, Frederick E. Millard, and Ithaar H. Derweesh Seth A. CohenSeth A. Cohen San Diego, CA More articles by this author , Kerrin L. PalazziKerrin L. Palazzi San Diego, CA More articles by this author , Wassim M. BazziWassim M. Bazzi San Diego, CA More articles by this author , J. Kellogg ParsonsJ. Kellogg Parsons San Diego, CA More articles by this author , Sean P. StroupSean P. Stroup San Diego, CA More articles by this author , Samuel K. ParkSamuel K. Park San Diego, CA More articles by this author , Frederick E. MillardFrederick E. Millard San Diego, CA More articles by this author , and Ithaar H. DerweeshIthaar H. Derweesh San Diego, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.936AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peri-operative outcomes of minimally invasive retroperitoneal lymph node dissection (MIS-RPLND) remain undefined. In a national cohort, we characterized the utilization of MIS-RPLND and compared peri-operative outcomes to open retroperitoneal lymph node dissection (O-RPLND). METHODS The U.S. Nationwide Inpatient Sample (NIS), the largest all-payer inpatient care database in the United States, was queried to identify men over 18 years of age, with a diagnosis of testicular malignancy, undergoing RPLND between 1998 and 2009. ICD-9 codes were used to stratify patients into those undergoing O-RPLND versus MIS-RPLND (including robotic-assisted and laparoscopic technique). We compared demographics, peri-operative outcomes, complications, and Patient Safety Indicators (PSIs) between O-RPLND and MIS-RPLND utilizing univariate and multivariate regression. RESULTS We identified 7,078 men: 6,926 undergoing O-RPNLD and 153 undergoing MIS-RPLND. While the prevalence of O-RPLND remained stable, the prevalence of MIS-RPLND increased significantly (p=0.032) during the study period. Compared to O-RPLND, MIS-RPLND patients had lower Charlson comorbidity indices (p=0.007) and appear to have undergone surgery at hospitals located in lower income areas (p=0.025). There were no differences in mean age (p=0.956), teaching hospital status (p=0.322), or hospital location (urban vs. rural, p=0.593). Median length of stay (LOS) was significantly shorter for MIS-RPLND (2 days) compared to O-RPLND (5 days, p<0.001). There were no differences in MIS-RPLND versus O-RPLND mortality (0% versus 0.2%, p=0.822), complications (10% versus 15.4%, p=0.385), or prevalence of PSIs (0% versus 4.6%, p=0.460). In multivariate regression, mode of surgery was not a significant predictor of complications (p=0.499). CONCLUSIONS Although the national prevalence of MIS-RPLND is low, it is increasing. Compared to O-RPLND, MIS-RPLND is associated with decreased LOS and comparable peri-operative safety outcomes. This is in the context of MIS-RPLND patients having lower Charlson comorbidity indices, indicating a component of selection bias. Further study is needed to insure the continued safe diffusion of this surgical innovation and promote appropriate patient selection. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e344 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seth A. Cohen San Diego, CA More articles by this author Kerrin L. Palazzi San Diego, CA More articles by this author Wassim M. Bazzi San Diego, CA More articles by this author J. Kellogg Parsons San Diego, CA More articles by this author Sean P. Stroup San Diego, CA More articles by this author Samuel K. Park San Diego, CA More articles by this author Frederick E. Millard San Diego, CA More articles by this author Ithaar H. Derweesh San Diego, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...