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Robot-Assisted Versus Open Radical Prostatectomy: The Differential Effect of Regionalization, Procedure Volume and Operative Approach

2012; Lippincott Williams & Wilkins; Volume: 189; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2012.10.028

1527-3792

Jesse D. Sammon, Pierre I. Karakiewicz, Maxine Sun, Shyam Sukumar, Praful Ravi, Khurshid R. Ghani, Marco Bianchi, James O. Peabody, Shahrokh F. Shariat, Paul Perrotte, Jim C. Hu, Mani Menon, Quoc‐Dien Trinh,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult Urology1 Apr 2013Robot-Assisted Versus Open Radical Prostatectomy: The Differential Effect of Regionalization, Procedure Volume and Operative Approach Jesse D. Sammon, Pierre I. Karakiewicz, Maxine Sun, Shyam Sukumar, Praful Ravi, Khurshid R. Ghani, Marco Bianchi, James O. Peabody, Shahrokh F. Shariat, Paul Perrotte, Jim C. Hu, Mani Menon, and Quoc-Dien Trinh Jesse D. SammonJesse D. Sammon Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan Equal study contribution. More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Equal study contribution. More articles by this author , Maxine SunMaxine Sun Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author , Shyam SukumarShyam Sukumar Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Praful RaviPraful Ravi Department of Urology, University of Cambridge, Cambridge, United Kingdom More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Marco BianchiMarco Bianchi Department of Urology, Universita Vita Salute San Raffaele, Milan, Italy More articles by this author , James O. PeabodyJames O. Peabody Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, Weill Medical College of Cornell University, New York, New York More articles by this author , Paul PerrottePaul Perrotte Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author , Jim C. HuJim C. Hu Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California More articles by this author , Mani MenonMani Menon Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.10.028AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical prostatectomy, while considering the impact of this established relationship. Materials and Methods: Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical prostatectomy overall and across volume quartiles. Results: An estimated 77,616 men underwent radical prostatectomy, including a robot-assisted and an open procedure in 63.9% and 36.1%, respectively. Low volume centers averaged 26.2 robot-assisted and 5.2 open cases, while very high volume centers averaged 578.8 robot-assisted and 150.2 open cases. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for all measured categories. Across equivalent volume quartiles robot-assisted radical prostatectomy outcomes were generally favorable. However, the open procedure at high volume centers resulted in a lower postoperative complication rate (OR 0.59, 95% CI 0.46–0.75), elevated hospital charges (OR 0.75, 95% CI 0.64–0.87) and a comparable blood transfusion rate (OR 1.38, 95% CI 0.93–2.02) relative to the robot-assisted procedure at low volume centers. Conclusions: Regionalization has occurred to a greater extent for robot-assisted than for open radical prostatectomy with an associated benefit in overall outcomes. 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Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChang P, Wagner A, Regan M, Smith J, Saigal C, Litwin M, Hu J, Cooperberg M, Carroll P, Klein E, Kibel A, Andriole G, Han M, Partin A, Wood D, Crociani C, Greenfield T, Patil D, Hembroff L, Davis K, Stork L, Spratt D, Wei J and Sanda M (2021) Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 ConsortiumJournal of Urology, VOL. 207, NO. 1, (127-136), Online publication date: 1-Jan-2022.Gershman B, Meier S, Jeffery M, Moreira D, Tollefson M, Kim S, Karnes R and Shah N (2017) Redefining and Contextualizing the Hospital Volume-Outcome Relationship for Robot-Assisted Radical Prostatectomy: Implications for Centralization of CareJournal of Urology, VOL. 198, NO. 1, (92-99), Online publication date: 1-Jul-2017.Cadeddu J (2017) Re: Robot-Assisted versus Open Radical Prostatectomy: A Contemporary Analysis of an All-Payer Discharge DatabaseJournal of Urology, VOL. 197, NO. 6, (1458-1458), Online publication date: 1-Jun-2017.Taneja S (2016) Re: Robot-Assisted Laparoscopic Prostatectomy versus Open Radical Retropubic Prostatectomy: Early Outcomes from a Randomised Controlled Phase 3 StudyJournal of Urology, VOL. 197, NO. 1, (151-151), Online publication date: 1-Jan-2017.Cole A, Leow J, Chang S, Chung B, Meyer C, Kibel A, Menon M, Nguyen P, Choueiri T, Reznor G, Lipsitz S, Sammon J, Sun M and Trinh Q (2016) Surgeon and Hospital Level Variation in the Costs of Robot-Assisted Radical ProstatectomyJournal of Urology, VOL. 196, NO. 4, (1090-1095), Online publication date: 1-Oct-2016.Taneja S (2014) Re: Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination EraJournal of Urology, VOL. 192, NO. 6, (1664-1665), Online publication date: 1-Dec-2014.Abd-El-Barr A, Sukumar S, Trinh Q, Roghmann F and Sun M (2013) Re: Surgeon Variation in Patient Quality of Life after Radical ProstatectomyJournal of Urology, VOL. 190, NO. 4, (1441-1442), Online publication date: 1-Oct-2013. Volume 189Issue 4April 2013Page: 1289-1294Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsroboticsprostatic neoplasmsprostateprostatectomy outcome and process assessment (health care)MetricsAuthor Information Jesse D. Sammon Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan Equal study contribution. More articles by this author Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Equal study contribution. More articles by this author Maxine Sun Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Shyam Sukumar Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Praful Ravi Department of Urology, University of Cambridge, Cambridge, United Kingdom More articles by this author Khurshid R. Ghani Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Marco Bianchi Department of Urology, Universita Vita Salute San Raffaele, Milan, Italy More articles by this author James O. Peabody Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Shahrokh F. Shariat Department of Urology, Weill Medical College of Cornell University, New York, New York More articles by this author Paul Perrotte Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Jim C. Hu Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California More articles by this author Mani Menon Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Quoc-Dien Trinh Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...