MP78-05 OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A CONTEMPORARY ANALYSIS OF AN ALL-PAYER DISCHARGE DATABASE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 2015MP78-05 OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A CONTEMPORARY ANALYSIS OF AN ALL-PAYER DISCHARGE DATABASE Jeffrey Leow, Christian Meyer, Julian Hanske, Marianne Schmid, Benjamin Chung, Quoc-Dien Trinh, and Steven Chang Jeffrey LeowJeffrey Leow More articles by this author , Christian MeyerChristian Meyer More articles by this author , Julian HanskeJulian Hanske More articles by this author , Marianne SchmidMarianne Schmid More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2821AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted radical prostatectomy (RARP) has been rapidly adopted in the United States despite the lack of Level 1 evidence. There is no conclusive evidence regarding its morbidity profile compared to open RP (ORP). The aim of this study was to compare perioperative outcomes of RARP vs. ORP on a contemporary cohort of patients using an all-payer discharge database. METHODS Using the Premier Hospital Database, which collects data from over 600 non-federal hospitals throughout the US, we captured all patients who underwent a radical prostatectomy (ICD-9 code 60.5) with diagnoses of prostate cancer (185) from 2003 to 2013. We classified procedures as “RARP” through a review of the charge description master for each patient specifically identifying supplies unique to robotic procedures. We evaluated 90-day postoperative complications (using Clavien classification), transfusion of blood products, operating room time, and length of stay. We also evaluated 90-day direct hospital costs, including cost breakdowns (room and board, operating room, supplies, etc.) We performed adjusted analyses, adjusting for potential confounders. We accounted for clustering by hospitals and survey weighting to ensure nationally representative estimates. RESULTS Over the 11-year study period, there was a total of 345,313 ORP and 328,731 RARP. The use of RARP grew rapidly from 2% in 2003 to 85% in 2013 (p<0.001) (Fig. 1). On adjusted analyses, compared to ORP, RARP patients were less likely to suffer major complications (OR 0.77, p=0.03), readmissions (OR 0.81, p=0.02), receive blood products (IRR 0.31, p<0.001) or have prolonged LOS (OR 0.27, p<0.001). LOS was shorted in the RARP group by nearly a day (0.88, p<0.001). Mean operating room time for RARP was longer by 71 min (p<0.001); higher surgeon and hospital volume were significant predictors of shorter OR time. RARP incurred $4085 more 90-day direct hospital costs (p<0.001) compared to ORP and this was primarily attributed to OR and supplies costs. CONCLUSIONS Our contemporary analysis of men who underwent radical prostatectomy found that the robotic approach appears to confer a morbidity advantage in the perioperative setting. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1003-e1004 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Leow More articles by this author Christian Meyer More articles by this author Julian Hanske More articles by this author Marianne Schmid More articles by this author Benjamin Chung More articles by this author Quoc-Dien Trinh More articles by this author Steven Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...