Use, Costs and Comparative Effectiveness of Robotic Assisted, Laparoscopic and Open Urological Surgery
2012; Lippincott Williams & Wilkins; Volume: 187; Issue: 4 Linguagem: Inglês
10.1016/j.juro.2011.11.089
ISSN1527-3792
AutoresHua‐yin Yu, Nathanael D. Hevelone, Stuart R. Lipsitz, Keith Kowalczyk, Jim C. Hu,
Tópico(s)Renal and Vascular Pathologies
ResumoNo AccessJournal of UrologyAdult Urology1 Apr 2012Use, Costs and Comparative Effectiveness of Robotic Assisted, Laparoscopic and Open Urological Surgery Hua-yin Yu, Nathanael D. Hevelone, Stuart R. Lipsitz, Keith J. Kowalczyk, and Jim C. Hu Hua-yin YuHua-yin Yu Division of Urology, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts , Nathanael D. HeveloneNathanael D. Hevelone Center for Surgery and Public Health, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts , Stuart R. LipsitzStuart R. Lipsitz Center for Surgery and Public Health, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts , Keith J. KowalczykKeith J. Kowalczyk Division of Urology, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts , and Jim C. HuJim C. Hu Division of Urology, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts Center for Surgery and Public Health, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts View All Author Informationhttps://doi.org/10.1016/j.juro.2011.11.089AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Although robotic assisted laparoscopic surgery has been aggressively marketed and rapidly adopted, there are few comparative effectiveness studies that support its purported advantages compared to open and laparoscopic surgery. We used a population based approach to assess use, costs and outcomes of robotic assisted laparoscopic surgery vs laparoscopic surgery and open surgery for common robotic assisted urological procedures. Materials and Methods: From the Nationwide Inpatient Sample we identified the most common urological robotic assisted laparoscopic surgery procedures during the last quarter of 2008 as radical prostatectomy, nephrectomy, partial nephrectomy and pyeloplasty. Robotic assisted laparoscopic surgery, laparoscopic surgery and open surgery use, costs and inpatient outcomes were compared using propensity score methods. Results: Robotic assisted laparoscopic surgery was performed for 52.7% of radical prostatectomies, 27.3% of pyeloplasties, 11.5% of partial nephrectomies and 2.3% of nephrectomies. For radical prostatectomy robotic assisted laparoscopic surgery was more prevalent than open surgery among white patients in high volume, urban hospitals (all p ≤0.015). Geographic variations were found in the use of robotic assisted laparoscopic surgery vs open surgery. Robotic assisted laparoscopic surgery and laparoscopic surgery vs open surgery were associated with shorter length of stay for all procedures, with robotic assisted laparoscopic surgery being the shortest for radical prostatectomy and partial nephrectomy (all p <0.001). For most procedures robotic assisted laparoscopic surgery and laparoscopic surgery vs open surgery resulted in fewer deaths, complications, transfusions and more routine discharges. However, robotic assisted laparoscopic surgery was more costly than laparoscopic surgery and open surgery for most procedures. Conclusions: While robotic assisted and laparoscopic surgery are associated with fewer deaths, complications, transfusions and shorter length of hospital stay compared to open surgery, robotic assisted laparoscopic surgery is more costly than laparoscopic and open surgery. 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Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byColaco M, Caveney M and Terlecki R (2017) Performance of Adult Pyeloplasty Relative to Endourological Management in the Era of Robotic Surgery: Data from the Nationwide Inpatient SampleUrology Practice, VOL. 5, NO. 2, (120-123), Online publication date: 1-Mar-2018.Krasnow R, Mossanen M, Koo S, Kubiak D, Preston M, Chung B, Kibel A and Chang S (2017) Prophylactic Antibiotics and Postoperative Complications of Radical Cystectomy: A Population Based Analysis in the United StatesJournal of Urology, VOL. 198, NO. 2, (297-304), Online publication date: 1-Aug-2017.Weinberg A, Wright J, Whalen M, Paulucci D, Woldu S, Berger S, Deibert C, Korets R, Hershman D, Neugut A and Badani K (2016) Use of Partial Nephrectomy after Acquisition of a Surgical Robot: A Population Based StudyUrology Practice, VOL. 3, NO. 6, (430-436), Online publication date: 1-Nov-2016.Weinberg A, Whalen M, Paulucci D, Woldu S, Deibert C, Korets R and Badani K (2016) Utilization of the Robotic Surgical Platform for Radical Nephrectomy: A National Comparison of Trends for Open, Laparoscopic and Robotic ApproachesUrology Practice, VOL. 3, NO. 3, (187-194), Online publication date: 1-May-2016.Laviana A, Kundavaram C, Tan H, Burke M, Niedzwiecki D, Lee R and Hu J (2016) Determining the True Costs of Treating Small Renal Masses Using Time Driven, Activity Based CostingUrology Practice, VOL. 3, NO. 3, (180-186), Online publication date: 1-May-2016.Tabayoyong W, Abouassaly R, Kiechle J, Cherullo E, Meropol N, Shah N, Dong S, Thompson R, Smaldone M, Zhu H, Ialacci S and Kim S (2015) Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal MassesJournal of Urology, VOL. 194, NO. 6, (1548-1553), Online publication date: 1-Dec-2015.Lorentz C, Leung A, DeRosa A, Perez S, Johnson T, Sweeney J and Master V (2015) Predicting Length of Stay Following Radical Nephrectomy Using the National Surgical Quality Improvement Program DatabaseJournal of Urology, VOL. 194, NO. 4, (923-928), Online publication date: 1-Oct-2015.Yang D, Monn M, Bahler C and Sundaram C (2014) Does Robotic Assistance Confer an Economic Benefit during Laparoscopic Radical Nephrectomy?Journal of Urology, VOL. 192, NO. 3, (671-676), Online publication date: 1-Sep-2014.Ghani K, Sukumar S, Sammon J, Rogers C, Trinh Q and Menon M (2013) Practice Patterns and Outcomes of Open and Minimally Invasive Partial Nephrectomy Since the Introduction of Robotic Partial Nephrectomy: Results from the Nationwide Inpatient SampleJournal of Urology, VOL. 191, NO. 4, (907-913), Online publication date: 1-Apr-2014.Varda B, Johnson E, Clark C, Chung B, Nelson C and Chang S (2013) National Trends of Perioperative Outcomes and Costs for Open, Laparoscopic and Robotic Pediatric PyeloplastyJournal of Urology, VOL. 191, NO. 4, (1090-1096), Online publication date: 1-Apr-2014.Monn M, Bahler C, Schneider E and Sundaram C (2012) Emerging Trends in Robotic Pyeloplasty for the Management of Ureteropelvic Junction Obstruction in AdultsJournal of Urology, VOL. 189, NO. 4, (1352-1357), Online publication date: 1-Apr-2013.Gadzinski A, Dimick J, Ye Z and Miller D (2012) Inpatient Urological Surgery at Critical Access Hospitals in the United StatesJournal of Urology, VOL. 189, NO. 4, (1475-1480), Online publication date: 1-Apr-2013.Jacobs B, Zhang Y, Skolarus T, Wei J, Montie J, Schroeck F and Hollenbeck B (2012) Certificate of Need Legislation and the Dissemination of Robotic Surgery for Prostate CancerJournal of Urology, VOL. 189, NO. 1, (80-85), Online publication date: 1-Jan-2013.Boorjian S (2012) Trends in Minimally Invasive Surgery for the Kidney and Prostate—When are You Doing the Patient a Disservice by Not Referring?Journal of Urology, VOL. 188, NO. 3, (702-703), Online publication date: 1-Sep-2012.Sukumar S, Sun M, Karakiewicz P, Friedman A, Chun F, Sammon J, Ghani K, Ravi P, Bianchi M, Jeong W, Shariat S, Hansen J, Peabody J, Elder J, Menon M and Trinh Q (2012) National Trends and Disparities in the Use of Minimally Invasive Adult PyeloplastyJournal of Urology, VOL. 188, NO. 3, (913-918), Online publication date: 1-Sep-2012. (2012) Reply by AuthorsJournal of Urology, VOL. 187, NO. 5, (1638-1638), Online publication date: 1-May-2012. Volume 187Issue 4April 2012Page: 1392-1399Supplementary Materials Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordscosts and cost analysisroboticstreatment outcomelaparoscopyurologic surgical proceduresMetrics Author Information Hua-yin Yu Division of Urology, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Nathanael D. Hevelone Center for Surgery and Public Health, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Stuart R. Lipsitz Center for Surgery and Public Health, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Keith J. Kowalczyk Division of Urology, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Jim C. Hu Division of Urology, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts Center for Surgery and Public Health, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Advertisement PDF downloadLoading ...
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