Prior to the introduction and dissemination of robot-assisted radical prostatectomy (RARP), population-based studies comparing open radical prostatectomy (ORP) and minimally invasive radical prostatectomy (MIRP) found no clinically significant difference in perioperative complication rates.
Assess the rate of RARP utilization and reexamine the difference in perioperative complication rates between RARP and ORP in light of RARP's supplanting laparoscopic radical prostatectomy (LRP) as the most common MIRP technique.
Design, setting, and participants
As of October 2008, a robot-assisted modifier was introduced to denote robot-assisted procedures. Relying on the Nationwide Inpatient Sample between October 2008 and December 2009, patients treated with radical prostatectomy (RP) were identified. The robot-assisted modifier (17.4x) was used to identify RARP (n
All patients underwent RARP or ORP.
We compared the rates of blood transfusions, intraoperative and postoperative complications, prolonged length of stay (pLOS), and in-hospital mortality. Multivariable logistic regression analyses of propensity score–matched populations, fitted with general estimation equations for clustering among hospitals, further adjusted for confounding factors.
Results and limitations
Of 19 462 RPs, 61.1% were RARPs, 38.0% were ORPs, and 0.9% were LRPs. In multivariable analyses of propensity score–matched populations, patients undergoing RARP were less likely to receive a blood transfusion (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.28–0.40), to experience an intraoperative complication (OR: 0.47; 95% CI, 0.31–0.71) or a postoperative complication (OR: 0.86; 95% CI, 0.77–0.96), and to experience a pLOS (OR: 0.28; 95% CI, 0.26–0.30). Limitations of this study include lack of adjustment for tumor characteristics, surgeon volume, learning curve effect, and longitudinal follow-up.
RARP has supplanted ORP as the most common surgical approach for RP. Moreover, we demonstrate superior adjusted perioperative outcomes after RARP in virtually all examined outcomes.
Keywords: Prostatic neoplasms, Prostatectomy, Minimally invasive, Robotic, Open.
a Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
b Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
c Department of Urology, University of Cambridge, Cambridge, UK
d Department of Urology, Universita Vita Salute San Raffaele, Milan, Italy
e Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
f Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
These authors are equal contributing first authors.
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© 2011 European Association of Urology, Published by Elsevier B.V.