Nationwide Evaluation of Robotic Prostatectomy – Outcomes, Cost, and Regionalization Compared to Laparoscopic and Open

Blair A Wormer, MD, Kristopher B Williams, MD, Joel F Bradley, MD, Amanda L Walters, MS, Vedra A Augenstein, MD, Kristian T Dacey, MHA, Brant T Heniford, MD

Carolinas Medical Center

Robotic prostatectomy (RP) is the most commonly performed robotic operation. The purpose of this study was to use a nationwide database to evaluate the outcomes, cost and regionalization of RP compared to laparoscopic (LP) and open (OP) prostatectomy.

The Nationwide Inpatient Sample, which captures approximately 20% of all US inpatient admissions, was queried from October 2008 (the inception of the robotic ICD-9 CM code) to December 2010 for patients with a diagnosis of prostate cancer undergoing elective RP, LP, and OP. Statistical analysis on unweighted figures was performed.

In total, there were 31,570 prostatectomies: RP – 19,889(63%), LP – 473(1.5%), and OP -11,208(35.5%). When comparing RP to LP and OP, there was no difference in age, however more LP were obese than RP (9.7% v. 7.1%; p= 0.0259) and OP (9.7% v. 6.9%; p=0.0196). OP had a statistically higher Charlson Comorbidity Index (CCI) than RP (2.5±1.2 v. 2.4±1.0; p<0.0001); there was no difference in CCI between LP and RP or OP.

Regional lymph node dissection was performed less in RP than LP (31% v 47%; p<0.0001) and OP (31% v. 39%; p<0.0001). Radical lymph node dissection was performed less in RP than LP (4.5% v. 10.4%; p<0.0001) and OP (4.5% v. 14.2%; p<0.0001). Any extent of lymph node dissection was performed less in RP than LP (47% v. 69%; p<0.0001) and OP (47% v. 73%; p<0.0001). Overall postoperative complication rate was lower in RP compared to LP (4.6% v. 6.6%; p=0.0461) and OP (4.6% v. 6.7%; p<0.0001). Mortality was statistically lower in RP compared to LP (0.01% v. 0.21%; p<0.0001) and OP (0.01% v. 0.09%; p=0.0002). Length of stay (LOS) was statistically shorter for RP than LP (1.7±1.8 v. 2.1±3.4days; p<0.0001) and OP (1.7±1.8 v. 2.6±2.2days; p<0.0001). Total hospitalization charge for RP was more than LP ($38,938±24,898 v. $34,893±23,546; p<0.0001) and OP ($38,938±24,898 v. $32,616±27,743; p<0.0001).

In high median income areas (>$45,000 annual), RP was performed less than LP (65% v. 75%; p=0.0007), but more than OP (65% v. 56%; p<0.0001). In teaching hospitals, RP was performed less than LP (75% v. 84%; p<0.0001) but more than OP (75% v. 60%; p<0.0001). When comparing RP to OP, RP is performed more often at smaller hospitals by bed size than OP (21% v. 13%; p<0.0001) and LP (21% v. 11%).

In the largest nationwide evaluation of robotic prostatectomy to date, when compared to laparoscopic and open, RP is associated with a decreased overall postoperative complication rate and length of stay; however, it is more costly and associated with a substantially lower rate of lymph node dissection. Although RP is being performed at more teaching hospitals in high income areas, it also outweighs open and laparoscopic at smaller bed size hospitals.

Session: Poster Presentation

Program Number: P645

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