Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination Era
- 10 May 2014
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 32 (14), 1419-1426
- https://doi.org/10.1200/jco.2013.53.5096
Abstract
Purpose Given the lack of randomized trials comparing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we sought to re-examine the outcomes of these techniques using a cohort of patients treated in the postdissemination era. Patients and Methods Overall, data from 5,915 patients with prostate cancer treated with RARP or ORP within the SEER-Medicare linked database diagnosed between October 2008 and December 2009 were abstracted. Postoperative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies, and costs of care within the first year after surgery were compared between the two surgical approaches. To decrease the effect of unmeasured confounders, instrumental variable analysis was performed. Multivariable logistic regression analyses were then performed. Results Overall, 2,439 patients (41.2%) and 3,476 patients (58.8%) underwent ORP and RARP, respectively. In multivariable analyses, patients undergoing RARP had similar odds of overall complications, readmission, and additional cancer therapies compared with patients undergoing ORP. However, RARP was associated with a higher probability of experiencing 30- and 90-day genitourinary and miscellaneous medical complications (all P ≤ .02). Additionally, RARP led to a lower risk of experiencing blood transfusion and of having a pLOS (all P < .001). Finally, first-year reimbursements were greater for patients undergoing RARP compared with ORP (P < .001). Conclusion RARP and ORP have comparable rates of complications and additional cancer therapies, even in the postdissemination era. Although RARP was associated with lower risk of blood transfusions and a slightly shorter length of stay, these benefits do not translate to a decrease in expenditures.Keywords
This publication has 31 references indexed in Scilit:
- Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health ServiceEuropean Urology, 2013
- National trends in hospital-acquired preventable adverse events after major cancer surgery in the USABMJ Open, 2013
- Use of Advanced Treatment Technologies Among Men at Low Risk of Dying From Prostate CancerJAMA, 2013
- Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical ProstatectomyEuropean Urology, 2012
- Contemporary Open and Robotic Radical Prostatectomy Practice Patterns Among Urologists in the United StatesJournal of Urology, 2012
- A Population-Based Analysis of Temporal Perioperative Complication Rates After Minimally Invasive Radical ProstatectomyEuropean Urology, 2011
- Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate CancerJournal of Clinical Oncology, 2011
- EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Treatment of Clinically Localised DiseaseEuropean Urology, 2010
- Comparative Effectiveness of Minimally Invasive vs Open Radical ProstatectomyJAMA, 2009
- Overview of the SEER-Medicare DataMedical Care, 2002