1784 COMPARATIVE EFFECTIVENESS OF ROBOTIC-ASSISTED, LAPAROSCOPIC AND OPEN RADICAL PROSTATECTOMY
2011; Lippincott Williams & Wilkins; Volume: 185; Issue: 4S Linguagem: Inglês
10.1016/j.juro.2011.02.2134
ISSN1527-3792
AutoresHua‐yin Yu, Nathanael D. Hevelone, Stuart R. Lipsitz, Jim C. Hu,
Tópico(s)Prostate Cancer Diagnosis and Treatment
ResumoYou have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111784 COMPARATIVE EFFECTIVENESS OF ROBOTIC-ASSISTED, LAPAROSCOPIC AND OPEN RADICAL PROSTATECTOMY Hua-yin Yu, Nathanael Hevelone, Stuart Lipsitz, and Jim Hu Hua-yin YuHua-yin Yu Boston, MA More articles by this author , Nathanael HeveloneNathanael Hevelone Boston, MA More articles by this author , Stuart LipsitzStuart Lipsitz Boston, MA More articles by this author , and Jim HuJim Hu Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2134AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic-assisted laparoscopic radical prostatectomy (RALP) has gained widespread popularity over laparoscopic and open radical retropubic prostatectomy (LRP and RRP). However, most data are derived from single center series and there is little evidence to support the purported advantages of RALP that have driven its use over LRP and RRP, nor to compare outcomes on a nationwide level. We aim to describe national utilization rates and inpatient outcomes of RALP, LRP and RRP. METHODS We used International Classification of Diseases, 9th Edition codes to compare the utilization and inpatient outcomes (length of stay (LOS) and complications) of RALP, LRP and RRP from the Nationwide Inpatient Sample during the last quarter of 2008. Adjusted analyses were performed using weighted propensity score methods, and general estimating equations were used to control for prostatectomy hospital clustering. RESULTS RALP accounted for 52.7% of prostatectomy procedures and was more commonly performed among white men and in urban teaching hospitals. Age, primary payer, income, hospital bed size, and geographic region were not significantly different (Table 1). RALP and LRP were associated with shorter mean LOS (1.7 and 2.0, vs. 2.4 days), lower heterologous transfusion rates (1.6% and 0.6%, vs. 5.3%), and fewer respiratory complications than RRP (1.0% and 1.8%, vs. 2.3%). (Table 2) There were no deaths during RALP or LRP hospitalizations, whereas there was 0.2% mortality during RRP hospitalizations. TABLE 1. CHARACTERISTICS OF STUDY SAMPLE Before Propensity Weighting⁎ After Propensity Weighting⁎ RALP LRP RRP p value RALP LRP RRP p value n=11512(52.7) n=617(2.8) n=9704(44.4) n= 2284(53.1) n=105(2.4) n=1910(44.4) Mean age <50 996 (8.7) 63(10.0) 764(7.9) 0.262 1860(8.2) 8(7.6) 156(8.2) 1.000 50–59 4051(35.2) 277(44.8) 3597(37.1) 841(36.8) 38(36.4) 706(37.0) 60–69 5516(47.9) 249(40.3) 4449(45.9) 1070(36.8) 49(46.7) 890(46.6) ≥ 70 950(8.2) 29(4.7) 894(9.2) 188(8.2) 10(9.4) 159(8.3) Race/ethnicity White 7948(69.0) 398(64.5) 5794(59.7) 0.002 1499(65.6) 68(64.4) 1244(65.1) 0.997 Non-white 1727(15.0) 173(28.0) 1677(17.3) 362(15.8) 19(18.3) 298(15.6) Missing 1838(16.0) 46(7.5) 2233(23.0) 424(18.6) 18(17.4) 368(19.2) Primary payer Private 7647(66.4) 440(71.3) 6137(63.3) 0.202 1509(66.0) 68(64.7) 1262(66.1) 0.997 Medicare 3242(28.2) 144(23.4) 2877(29.6) 652(28.5) 30(29.0) 540(28.3) Medicaid/other 624(5.4) 33(5.3) 690(7.1) 124(5.4) 7(6.3) 108(5.7) ZIP code income quartile⁎⁎ 1st(lowest quartile) 1575(13.9) 105(15.5) 1791(19.2) 0.088 365(16.0) 20(19.3) 310(16.2) 0.986 2nd 2743(24.3) 108(18.1) 2237(23.9) 553(24.2) 27(26.1) 455(23.8) 3rd 2973(26.3) 138(23.1) 2375(25.4) 587(25.7) 20(19.4) 492(25.8) 4th 4001(35.4) 247(41.3) 2943(431.5) 779(34.1) 37(35.3) 653(34.2) Hospital type Rural 229(2.0) 5(0.8) 685(7.1) 0.015 86(3.8) 3(2.7) 81(4.2) 0.989 Urban non-teaching 3583(31.1) 103(16.7) 2691(27.7) 615(26.9) 31(29.7) 493(25.8) Urban teaching 7702(66.9) 509(82.5) 6328(65.2) 1583(69.3) 71(67.7) 1337(70.0) Hospital bed size Small 851(7.4) 31(5.0) 727(7.5) 0.106 165(7.2) 7(6.8) 135(7.1) 0.991 Medium 1637(14.2) 234(37.9) 2236(23.0) 436(19.1) 14(13.2) 360(18.9) Large 9025(78.4) 353(57.1) 6741(69.5) 1684(73.7) 84(80.0) 1415(74.1) Hospital region Northeast 2352(20.4) 105(17.0) 1685(17.4) 0.596 456(20.0) 22(20.8) 387(20.2) 1.000 Midwest 3266(28.4) 107(17.4) 2057(21.2) 581(25.4) 30(28.6) 464(24.3) South 3834(33.3) 297(48.2) 3625(37.4) 805(35.2) 31(29.5) 682(35.7) West 2061(17.9) 108(17.4) 2337(24.1 443(19.4) 22(21.1) 378(19.8) RALP = Robotic assisted laparoscopic prostatectomy, LRP = Laparoscopic radical prostatectomy, RRP = Radical retropubic prostatectomy, LOS = length of stay, NA = Not applicable. ⁎ Due to need for rounding, column totals for n's may not add up to procedure totals and percent totals may not add up to 100. ⁎⁎ p value could not be calculated for categories where there were cells containing zero. TABLE 2. OUTCOMES BY SURGICAL APPROACH Before Propensity Weighting⁎ After Propensity Weighting⁎ RALP LRP RRP p value⁎⁎ RALP LRP RRP p value⁎⁎ n=11512(52.7) n=617(2.8) n=9704(44.4) n= 2284(53.1) n=105(2.4) n=1910(44.4) Mean LOS(days) 1.7 1.7 2.5 1.7 2.0 2.4 Heterologous transfusions 173(1.5) 5(0.8) 594(6.1) 37(1.6) 1(0.6) 101(5.3) Complications Cardiac 78(0.7) 5(0.9) 117(1.2) 0.213 16(0.7) 0(0) 22(1.1) NA Respiratory 133(1.1) 10(1.6) 215(2.2) 0.023 24(1) 2(1.8) 43(2.3) 0.016 Vascular 49(0.4) 0(0) 73(0.8) NA 9(0.4) 0(0) 15(0.8) NA Genitourinary 119(1.0) 10(1.7) 91(0.9) 0.727 26(1.1) 4(3.7) 20(1.1) 0.192 Wound 30(0.3) 0(0) 48(0.5) NA 5(0.2) 0(0) 12(0.6) NA Miscillaneous medical 554(4.8) 27(3.8) 497(5.1) 0.763 116(5.1) 9(8.7) 90(4.7) 0.343 Miscillaneous surgical 217(1.9) 15(2.4) 276(2.8) 0.111 45(2) 3(2.6) 50(2.6) 0.347 Death 0(0) 0(0) 15(0.2) NA 0(0) 0(0) 4(0.2) NA RALP = Robotic assisted laparoscopic prostatectomy, LRP = Laparoscopic radical prostatectomy, RRP = Radical retropubic prostatectomy, LOS = length of stay, NA = Not applicable. ⁎ Due to need for rounding, column totals for n's may not add up to procedure totals and percent totals may not add up to 100. ⁎⁎ p value could not be calculated for categories where there were cells containing zero. CONCLUSIONS Nationally, RALP and LRP were associated with fewer transfusions, respiratory complications, and shorter LOS than RRP, and RALP accounted for the majority of radical prostatectomies. Additional comparative studies are needed to compare long-term postoperative outcomes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e716-e717 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hua-yin Yu Boston, MA More articles by this author Nathanael Hevelone Boston, MA More articles by this author Stuart Lipsitz Boston, MA More articles by this author Jim Hu Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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