Platinum Priority – Prostate Cancer
Editorial by Joshua J. Meeks and James A. Eastham on pp. 686–687 of this issue

Perioperative Outcomes of Robot-Assisted Radical Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample eulogo1

By: Quoc-Dien Trinha b 1 lowast , Jesse Sammona 1, Maxine Sunb, Praful Ravic, Khurshid R. Ghania, Marco Bianchid, Wooju Jeonga, Shahrokh F. Shariate, Jens Hansenf, Jan Schmitgesf, Claudio Jeldresb, Craig G. Rogersa, James O. Peabodya, Francesco Montorsid, Mani Menona and Pierre I. Karakiewiczb

European Urology, Volume 61 Issue 4, April 2012, Pages 679-685

Published online: 01 April 2012

Keywords: Prostatic neoplasms, Prostatectomy, Minimally invasive, Robotic, Open

Abstract Full Text Full Text PDF (163 KB)



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=11 889). Patients with the minimally invasive modifier code (54.21) without the robot-assisted modifier were classified as having undergone LRP and were removed from further analyses. The remainder were classified as ORP patients (n=7389).


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.

Take Home Message

Contemporary data from the United States demonstrate that robot-assisted radical prostatectomy has supplanted open radical prostatectomy as the most common surgical approach for prostate cancer. Adjusted analyses demonstrate superior perioperative outcomes after robot-assisted radical prostatectomy in virtually all of the 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

lowast Corresponding author. Vattikuti Urology Institute, Henry Ford Health System, 2799W. Grand Blvd., Detroit, MI 48202, USA. Tel. +1 313 405 2829; Fax: +1 514 227 5103.

1 These authors are equal contributing first authors. Please visit to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

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