Increased Blood Loss and Extended Postoperative Length of Stay After Open Prostatectomy Compared to Robotic-Assisted Prostatectomy

Steven Groene, MD, Davis Heniford, James Mark, MD, Tanushree Prasad, MA, Amy Lincourt, PhD, MBA, Vedra Augenstein, MD, Brent Matthews, MD. Carolinas Medical Center

Introduction: The aim of this study was to compare perioperative outcomes and operative supply costs between open prostatectomy (OP) and robotic-assisted prostatectomy (RAP).

Methods: A precise random sample, representative of the 2014 OP and RAP patient population at a single institution was generated and analyzed. Demographics, operative details and post-operative outcomes were evaluated using standard statistical methods.

Results: Forty patients who underwent OP and 40 RAP were selected.  There were no significant differences in age, BMI, race, diabetes, COPD, CAD, hypertension, smoking, previous surgical history or tumor size.  Patients in the OP group were less likely to have prostate cancer (70% vs 97.5%;p=0.002), had shorter OR time (127.1±51.1 vs 188.5±48.4min;p<0.001), and had more intra-operative blood loss (519.4±318.8 vs 226.9±537.8ml;p<0.001), but did not require more blood transfusions.  While total operative supply cost for OPs was less than RAP ($497 vs $3103; p<0.001), the OPs were associated with a significantly longer LOS (3.0±2.1 vs 1.7±0.7days;p<0.001).  With an average follow up of 7.4±4.5 months between the groups, there were no significant differences in post-operative infectious complications, DVT, clinically significant incontinence requiring intervention, potency, cardiac events, bleeding, incisional hernias, readmissions, unplanned returns to the OR or mortality.

Conclusions: Patients undergoing OPs had similar demographics and pre-operative characteristics as those undergoing RAPs, other than that patients undergoing RAP were more likely to have cancer.  OP was associated with more intra-operative blood loss, shorter operative time but a longer LOS compared to RAPs.  Otherwise, post-operative outcomes were similar between the groups.

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