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Kuklinski D, Vogel J, Henschke C, Pross C, Geissler A. Robotic-assisted surgery for prostatectomy - does the diffusion of robotic systems contribute to treatment centralization and influence patients' hospital choice? HEALTH ECONOMICS REVIEW 2023; 13:29. [PMID: 37162648 PMCID: PMC10170785 DOI: 10.1186/s13561-023-00444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Between 2008 and 2018, the share of robotic-assisted surgeries (RAS) for radical prostatectomies (RPEs) has increased from 3 to 46% in Germany. Firstly, we investigate if this diffusion of RAS has contributed to RPE treatment centralization. Secondly, we analyze if a hospital's use of an RAS system influenced patients' hospital choice. METHODS To analyze RPE treatment centralization, we use (bi-) annual hospital data from 2006 to 2018 for all German hospitals in a panel-data fixed effect model. For investigating RAS systems' influence on patients' hospital choice, we use patient level data of 4614 RPE patients treated in 2015. Employing a random utility choice model, we estimate the influence of RAS as well as specialization and quality on patients' marginal utilities and their according willingness to travel. RESULTS Despite a slight decrease in RPEs between 2006 and 2018, hospitals that invested in an RAS system could increase their case volumes significantly (+ 82% compared to hospitals that did not invest) contributing to treatment centralization. Moreover, patients are willing to travel longer for hospitals offering RAS (+ 22% than average travel time) and for specialization (+ 13% for certified prostate cancer treatment centers, + 9% for higher procedure volume). The influence of outcome quality and service quality on patients' hospital choice is insignificant or negligible. CONCLUSIONS In conclusion, centralization is partly driven by (very) high-volume hospitals' investment in RAS systems and patient preferences. While outcome quality might improve due to centralization and according specialization, evidence for a direct positive influence of RAS on RPE outcomes still is ambiguous. Patients have been voting with their feet, but research yet has to catch up.
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Affiliation(s)
- David Kuklinski
- Chair for Healthcare Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland
| | - Justus Vogel
- Chair for Healthcare Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland.
| | - Cornelia Henschke
- Department of Health Care Management, Berlin University of Technology, Berlin Centre of Health Economics Research, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Christoph Pross
- Department of Health Care Management, Berlin University of Technology, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Alexander Geissler
- Chair for Healthcare Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland
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The application of 3D bioprinting in urological diseases. Mater Today Bio 2022; 16:100388. [PMID: 35967737 PMCID: PMC9364106 DOI: 10.1016/j.mtbio.2022.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Urologic diseases are commonly diagnosed health problems affecting people around the world. More than 26 million people suffer from urologic diseases and the annual expenditure was more than 11 billion US dollars. The urologic cancers, like bladder cancer, prostate cancer and kidney cancer are always the leading causes of death worldwide, which account for approximately 22% and 10% of the new cancer cases and death, respectively. Organ transplantation is one of the major clinical treatments for urological diseases like end-stage renal disease and urethral stricture, albeit strongly limited by the availability of matching donor organs. Tissue engineering has been recognized as a highly promising strategy to solve the problems of organ donor shortage by the fabrication of artificial organs/tissue. This includes the prospective technology of three-dimensional (3D) bioprinting, which has been adapted to various cell types and biomaterials to replicate the heterogeneity of urological organs for the investigation of organ transplantation and disease progression. This review discusses various types of 3D bioprinting methodologies and commonly used biomaterials for urological diseases. The literature shows that advances in this field toward the development of functional urological organs or disease models have progressively increased. Although numerous challenges still need to be tackled, like the technical difficulties of replicating the heterogeneity of urologic organs and the limited biomaterial choices to recapitulate the complicated extracellular matrix components, it has been proved by numerous studies that 3D bioprinting has the potential to fabricate functional urological organs for clinical transplantation and in vitro disease models. Outline the advantages and characteristics of 3D printing compared with traditional methods for urological diseases. Guide the selection of 3D bioprinting technology and material in urological tissue engineering. Discuss the challenges and future perspectives of 3D bioprinting in urological diseases and clinical translation.
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Phan YC, Babawale O, Karim O, Wilby D, Ismail M. A single institution experience: Robotic-assisted laparoscopic renal calyceal diverticulectomies, heminephrectomy and bladder diverticulectomies. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211029813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The use of a robotic surgical system has transformed modern urological surgeries. There is little reported, however, on the use of robotic surgical systems in the management of benign urological diseases. We aim to report our experience in robotic-assisted surgery in renal calyceal diverticulectomies, heminephrectomy and bladder diverticulectomies. Methodology: We retrospectively collected the data of patients who had robotic-assisted surgery in our institution from 1 January 2014 to 31 December 2019. Results: Over the last five years, our institution has performed over 1500 robotic-assisted urological surgeries. In this five-year period, four robotic surgeons have performed a total of 25 robotic assisted operations to treat benign urological diseases including three renal calyceal diverticulectomies, one heminephrectomy and two bladder diverticulectomies. All patients were satisfied with the outcomes of their surgery when reviewed at their follow up consultations. Conclusion: We report a very positive experience in using robotic surgical systems in managing our series of benign urological conditions in our hospital. We should not restrict the use of this tool to cancer surgery, but consider the technology in our surgical armamentarium for all aspects of our urological practice.
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Affiliation(s)
| | | | - Omer Karim
- Queen Alexandra Hospital, Portsmouth, UK
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Ravivarapu KT, Omidele O, Pfail J, Tomer N, Small AC, Palese MA. Robotic-assisted simple prostatectomy versus open simple prostatectomy: a New York statewide analysis of early adoption and outcomes between 2009 and 2017. J Robot Surg 2020; 15:627-633. [PMID: 33009988 DOI: 10.1007/s11701-020-01152-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
The factors driving early adoption of robotic-assisted simple prostatectomy (RASP) for large gland BPH have not yet been identified. This study aims to determine the patient, provider, and facility level differences and predictors in undergoing RASP versus OSP. This population-based cohort study used data from the all-payer New York State Statewide Planning and Research Cooperative System (SPARCS) database. Patient, provider, and facility characteristics for each cohort were analyzed, and a multivariate analysis was conducted to identify predictive factors associated with undergoing RASP versus OSP. From 2009 to 2017, 1881 OSP and 216 RASP cases were identified. RASP utilization increased from 2.6% of all cases in 2009 to 16.8% in 2017. Patient demographics were similar between both cohorts. Median length of stay was shorter for RASP patients (3 vs. 4 days, p < 0.001), and OSP was associated with a long length of stay (> 7 days) (p < 0.001). There were no significant differences in 30- and 90-day readmission rates or 1-year mortality. More OSP patients were discharged to continued care facilities than RASP patients (p = 0.049), and more RASP patients were discharged to home compared to OSP patients (p = 0.035). Positive predictors for undergoing RASP included teaching hospital status, medium and high hospital bed volume, high hospital operative volume, high surgeon volume, and surgeons that graduated within 15 years of surgery. As RASP shows favorable perioperative outcomes, the diffusion of robotic technology and newer graduates entering the workforce may augment the upward trend of RASP utilization.
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Affiliation(s)
- Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Olamide Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Alexander C Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1272, New York, NY, 10029, USA.
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5
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McClintock TR, Wang Y, Cole AP, Chung BI, Kibel AS, Chang SL, Trinh QD. Contemporary trends in the utilisation of radical prostatectomy. BJU Int 2018; 122:726-728. [PMID: 29797448 DOI: 10.1111/bju.14411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ye Wang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Chandrasekar T, Goldberg H, Klaassen Z, Sayyid RK, Hamilton RJ, Fleshner NE, Kulkarni GS. Lymphadenectomy in Gleason 7 prostate cancer: Adherence to guidelines and effect on clinical outcomes. Urol Oncol 2017; 36:13.e11-13.e18. [PMID: 28919181 DOI: 10.1016/j.urolonc.2017.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/24/2017] [Accepted: 08/22/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND To examine usage trends, guideline adherence, and survival data for patients undergoing lymphadenectomy (LND) at the time of radical prostatectomy (RP) for Gleason 7 prostate cancer (PCa). METHODS The SEER database was queried for all patients with nonmetastatic biopsy Gleason 7 PCa from 2004 to 2013. Distribution and trends of LND were analyzed. The Memorial-Sloan Kettering Cancer Center nomogram was applied to stratify patients based on risk of nodal disease at time of RP (<5% risk or ≥5% risk). Analyses were performed to determine covariates associated with LND receipt at time of RP and cancer-specific mortality (CSM). RESULTS A total of 78,641 patients with either G34 or G43 PCa underwent RP (59,194 and 19,447, respectively). Of these patients, 61.2% of G34 and 73.5% of G43 patients underwent LND. During this 10-year period, the proportion of G43 patients undergoing LND remained relatively stable, whereas the proportion of G34 patients undergoing LND ranged between 55.9% and 67.9%. Regional differences were a predictor of LND receipt regardless of risk stratification, but did not translate to higher risk of CSM. Receipt of LND was not predictive of improved CSM in any of the cohorts analyzed. CONCLUSIONS The role of LND for Gleason 7 prostate adenocarcinoma is not yet standardized, as indicated by the variability of LND dissection rates. Receipt of LND did not improve CSM, and in G43 patients, it predicted higher CSM. As the effect of LND on CSM is uncertain, further evaluation of oncologic benefit in this patient population is warranted.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Hanan Goldberg
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rashid K Sayyid
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Neil E Fleshner
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Löppenberg B, Friedlander DF, Krasnova A, Tam A, Leow JJ, Nguyen PL, Barry H, Lipsitz SR, Menon M, Abdollah F, Sammon JD, Sun M, Choueiri TK, Kibel AS, Trinh QD. Variation in the use of active surveillance for low-risk prostate cancer. Cancer 2017; 124:55-64. [DOI: 10.1002/cncr.30983] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/28/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Björn Löppenberg
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Marien Hospital Herne, Ruhr-University Bochum; Herne Germany
| | - David F. Friedlander
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Anna Krasnova
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Andrew Tam
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | | | - Paul L. Nguyen
- Department of Radiation Oncology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Hawa Barry
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Stuart R. Lipsitz
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Jesse D. Sammon
- Division of Urology and Center for Outcomes Research and Evaluation, Maine Medical Center; Portland Maine
| | - Maxine Sun
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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8
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Gershman B, Meier SK, Jeffery MM, Moreira DM, Tollefson MK, Kim SP, Karnes RJ, Shah ND. Redefining and Contextualizing the Hospital Volume-Outcome Relationship for Robot-Assisted Radical Prostatectomy: Implications for Centralization of Care. J Urol 2017; 198:92-99. [DOI: 10.1016/j.juro.2017.01.067] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Boris Gershman
- Division of Urology, Rhode Island Hospital and Miriam Hospital, Providence, Rhode Island
| | - Sarah K. Meier
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Molly M. Jeffery
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Daniel M. Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Simon P. Kim
- Department of Urology, Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Nilay D. Shah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- OptumLabs, Cambridge, Massachusetts
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9
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Sugihara T, Yasunaga H, Matsui H, Nagao G, Ishikawa A, Fujimura T, Fukuhara H, Fushimi K, Ohori M, Homma Y. Accessibility to surgical robot technology and prostate-cancer patient behavior for prostatectomy. Jpn J Clin Oncol 2017; 47:647-651. [PMID: 28419326 DOI: 10.1093/jjco/hyx052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical prostatectomy focusing on geographical accessibility. Methods In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical prostatectomy (divided by mean interval in 2011: % interval days to radical prostatectomy) were calculated for individual radical prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. Results % Interval days to radical prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-prostatectomy provider and temporal progress were other significant factors related to % interval days to radical prostatectomy widening (P < 0.05 for all). Conclusions Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.
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Affiliation(s)
- Toru Sugihara
- Department of Urology, Japanese Red Cross Medical Center, Tokyo.,Department of Urology, The University of Tokyo, Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo
| | - Go Nagao
- Department of Urology, Tokyo Medical University, Tokyo, Japan
| | - Akira Ishikawa
- Department of Urology, Japanese Red Cross Medical Center, Tokyo
| | | | | | - Kiyohide Fushimi
- Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Ohori
- Department of Urology, Tokyo Medical University, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, The University of Tokyo, Tokyo
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10
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Leow JJ, Leong EK, Serrell EC, Chang SL, Gruen RL, Png KS, Beaule LT, Trinh QD, Menon MM, Sammon JD. Systematic Review of the Volume-Outcome Relationship for Radical Prostatectomy. Eur Urol Focus 2017; 4:775-789. [PMID: 28753874 DOI: 10.1016/j.euf.2017.03.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Radical prostatectomy (RP) is one of the most complex urological procedures performed. Higher surgical volume has been found previously to be associated with better patient outcomes and reduced costs to the health care system. This has resulted in some regionalization of care toward high-volume facilities and providers; however, the preponderance of RPs is still performed at low-volume institutions. OBJECTIVE To provide an updated systematic review of the association of hospital and surgeon volume on patient and system outcomes after RP, including robot-assisted RP. EVIDENCE ACQUISITION A systematic review of literature was undertaken, searching PubMed (1959-2016) for original articles. Selection criteria included RP, hospital and/or surgeon volumes as predictor variables, categorization of hospital and/or surgeon volumes, and measurable end points. EVIDENCE SYNTHESIS Overall 49 publications fulfilled the inclusion criteria. Most of the studies demonstrated that higher-volume surgeries are associated with better outcomes including reduced mortality, morbidity, postoperative complications, length of stay, readmission, and cost-associated factors. The volume-outcome relationship is maintained in robotic surgery. Eleven studies assessed hospital and surgeon volume simultaneously, and findings reflect that neither is an independent predictor variable affecting outcomes. The studies varied in how volume cutoffs were categorized as well as how the volume-outcome relationship was methodologically evaluated. CONCLUSIONS Contemporary evidence continues to support the relationship between high-volume surgeries with improved RP outcomes. Recent studies demonstrate that the volume-outcome relationship applies to robot-assisted RP and may be applied for potential cost savings in health care. An increase in the number of international studies suggests reproducibility of the association. Although regionalization of surgical care remains a contentious issue, there is an increasing body of evidence that short-term outcomes are improved at high-volume centers for RP. PATIENT SUMMARY This systematic review of the latest literature found that higher surgical volume was associated with improved outcomes for radical prostatectomy.
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Affiliation(s)
- Jeffrey J Leow
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Eugene K Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore
| | | | - Steven L Chang
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell L Gruen
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore-Imperial College London, Singapore
| | - Keng Siang Png
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Lisa T Beaule
- Tufts University School of Medicine, Boston, MA, USA; Division of Urology, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mani M Menon
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- Tufts University School of Medicine, Boston, MA, USA; Division of Urology, Maine Medical Center, Portland, ME, USA; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA.
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11
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Maurice MJ, Zhu H, Kim SP, Abouassaly R. Robotic prostatectomy is associated with increased patient travel and treatment delay. Can Urol Assoc J 2016; 10:192-201. [PMID: 27713799 DOI: 10.5489/cuaj.3628] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION New technologies may limit access to treatment. We investigated radical prostatectomy (RP) access over time since robotic introduction and the impact of robotic use on RP access relative to other approaches in the modern era. METHODS Using the National Cancer Data Base, RPs performed during the eras of early (2004-2005) and late (2010-2011) robotic dissemination were identified. The primary endpoints, patient travel distance and treatment delay, were compared by era, and for 2010-2011, by surgical approach. Analyses included multivariable and multinomial logistic regression. RESULTS 138 476 cases were identified, 32% from 2004-2005 and 68% from 2010-2011. In 2010-2011, 74%, 21%, and 4.3% of RPs were robotic, open, and laparoscopic, respectively. Treatment in 2010-2011 and robotic approach were independently associated with increased patient travel distance and longer treatment delay (p<0.001). Men treated robotically had 1.1-1.2 times higher odds of traveling medium-to-long-range distances and 1.2-1.3 higher odds of delays 90 days or greater compared to those treated open (p<0.001). Laparoscopic approach was associated with increased patient travel and treatment delay, but to a lesser extent than the robotic approach (p<0.001). In high-risk patients, treatment delays remained significantly longer for minimally invasive approaches (p<0.001). Other factors associated with the robotic approach included referral from an outside facility, treatment at an academic or high-volume hospital, higher income, and private insurance. Potential limitations include the retrospective observational design and lack of external validation of the primary outcomes. CONCLUSIONS The robotic approach is associated with increased travel burden and treatment delay, potentially limiting access to surgical care.
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Affiliation(s)
- Matthew J Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Hui Zhu
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States;; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Simon P Kim
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, United States
| | - Robert Abouassaly
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, United States
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12
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Bijlani A, Hebert AE, Davitian M, May H, Speers M, Leung R, Mohamed NE, Sacks HS, Tewari A. A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:391-403. [PMID: 27325331 DOI: 10.1016/j.jval.2015.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 11/23/2015] [Accepted: 12/27/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND The economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses. OBJECTIVES The objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives. METHODS We performed a model-based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients' postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars. RESULTS Because of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy. CONCLUSIONS Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.
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Affiliation(s)
| | | | - Mike Davitian
- Intuitive Surgical, Sunnyvale, CA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Holly May
- Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Mark Speers
- Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA
| | - Robert Leung
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Nihal E Mohamed
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Henry S Sacks
- Thomas C. Chalmers Clinical Trials Unit, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Tewari
- Department of Urology, Mount Sinai Hospital, New York, NY, USA.
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13
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O'Neil B, Koyama T, Alvarez J, Conwill RM, Albertsen PC, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hoffman KE, Hoffman RM, Kaplan SH, Stanford JL, Stroup AM, Paddock LE, Wu XC, Stephenson RA, Resnick MJ, Barocas DA, Penson DF. The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples. J Urol 2016; 195:321-9. [PMID: 26343985 PMCID: PMC4916911 DOI: 10.1016/j.juro.2015.08.092] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy. MATERIALS AND METHODS Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS. RESULTS The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09-6.44) but not at 12 months (1.19, -1.32-3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02-10.56) and at 12 months (7.64, 5.25-10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results. CONCLUSIONS This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience less decline in early urinary continence and sexual function than those undergoing open radical prostatectomy. The clinical meaning of these differences is uncertain and longer followup will be required to establish whether these benefits are durable.
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Affiliation(s)
- Brock O'Neil
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee.
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - JoAnn Alvarez
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | | | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Michael Goodman
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | | | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sherrie H Kaplan
- Department of Medicine, University of California, Irvine, Irvine
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Xiao-Cheng Wu
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robert A Stephenson
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
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14
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Cary C, Odisho AY, Cooperberg MR. Variation in prostate cancer treatment associated with population density of the county of residence. Prostate Cancer Prostatic Dis 2016; 19:174-9. [PMID: 26782713 DOI: 10.1038/pcan.2015.65] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND We sought to assess variation in the primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to the county and state level. METHODS A total 138 226 men with clinically localized prostate cancer in the Surveillance, Epidemiology and End Result (SEER) database in 2005 through 2008 were analyzed. The main association of interest was between prostate cancer treatment and population density using multilevel hierarchical logit models while accounting for the random effects of counties nested within SEER regions. To quantify the effect of county and SEER region on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients. RESULTS Men with localized prostate cancer in metropolitan counties had 23% higher odds of being treated with surgery or radiation compared with men in rural counties, controlling for number of urologists per county as well as clinical and sociodemographic characteristics. Three percent (95% confidence interval (CI): 1.2-6.2%) of the total variation in treatment was attributable to SEER site, while 6% (95% CI: 4.3-9.0%) of variation was attributable to county of residence, adjusting for clinical and sociodemographic characteristics. CONCLUSIONS Variation in treatment for localized prostate cancer exists for men living in different population-dense counties of the country. These findings highlight the importance of comparative effectiveness research to improve understanding of this variation and lead to a reduction in unwarranted variation.
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Affiliation(s)
- C Cary
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - A Y Odisho
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - M R Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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15
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Kang CH, Bok JS, Lee NR, Kim YT, Lee SH, Lim C. Current Trend of Robotic Thoracic and Cardiovascular Surgeries in Korea: Analysis of Seven-Year National Data. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:311-7. [PMID: 26509124 PMCID: PMC4622026 DOI: 10.5090/kjtcs.2015.48.5.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 12/16/2022]
Abstract
Background Robotic surgery is an alternative to minimally invasive surgery. The aim of this study was to report on current trends in robotic thoracic and cardiovascular surgical techniques in Korea. Methods Data from the National Evidence-based Healthcare Collaborating Agency (NECA) between January 2006 and June 2012 were used in this study, including a total of 932 cases of robotic surgeries reported to NECA. The annual trends in the case volume, indications for robotic surgery, and distribution by hospitals and surgeons were analyzed in this study. Results Of the 932 cases, 591 (63%) were thoracic operations and 340 (37%) were cardiac operations. The case number increased explosively in 2007 and 2008. However, the rate of increase regained a steady state after 2011. The main indications for robotic thoracic surgery were pulmonary disease (n=271, 46%), esophageal disease (n=199, 34%), and mediastinal disease (n=117, 20%). The main indications for robotic cardiac surgery were valvular heart disease (n=228, 67%), atrial septal defect (n=79, 23%), and cardiac myxoma (n=27, 8%). Robotic thoracic and cardiovascular surgeries were performed in 19 hospitals. Three large volume hospitals performed 94% of the case volume of robotic cardiac surgery and 74% of robotic thoracic surgery. Centralization of robotic operation was significantly (p<0.0001) more common in cardiac surgery than in thoracic surgery. A total of 39 surgeons performed robotic surgeries. However, only 27% of cardiac surgeons and 23% of thoracic surgeons performed more than 10 cases of robotic surgery. Conclusion Trend analysis of robotic and cardiovascular operations demonstrated a gradual increase in the surgical volume in Korea. Meanwhile, centralization of surgical cases toward specific surgeons in specific hospitals was observed.
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Affiliation(s)
- Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Jin San Bok
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Na Rae Lee
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Seon Heui Lee
- Department of Nursing Science, Gachon University College of Nursing
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
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16
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Penson DF. Re: Exploring the Burden of Inpatient Readmissions after Major Cancer Surgery. J Urol 2015; 194:1068. [PMID: 26382809 DOI: 10.1016/j.juro.2015.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Indexed: 11/30/2022]
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17
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Baum N, Levy J. Methodology of patient care for elevated PSA after prostate cancer treatment: A primary care perspective. Postgrad Med 2015; 127:654-9. [PMID: 26118565 DOI: 10.1080/00325481.2015.1059248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Prostate cancer (PCa) remains one of the most common cancers in men. Each year there are 230,000 new cases and it causes nearly 30,000 deaths. Elevations in prostate-specific antigen (PSA) after treatment with radiation or surgery can indicate the presence of PCa recurrence. About 15-18% of men treated for PCa will have an elevation of their PSA, which is a source of great concern and will lead to a management discussion with the patient. Approximately 25-33% of men with PCa will experience a recurrence of their cancer after surgery or radiation. This article will discuss the different options for men with a rising PSA after definitive therapy or an attempt at curative treatment for PCa. The purpose of this article is to help the primary care doctor, internist and geriatrician to become knowledgeable about the treatment options of recurrent PCa so that they can participate in the discussion with the patient and help the patient reach a decision regarding treatment and management of the elevated PSA levels, which signal recurrent disease.
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Affiliation(s)
- Neil Baum
- Tulane Medical School - Urology , New Orleans, LA , USA
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18
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Carlsson S, Drevin L, Loeb S, Widmark A, Lissbrant IF, Robinson D, Johansson E, Stattin P, Fransson P. Population-based study of long-term functional outcomes after prostate cancer treatment. BJU Int 2015; 117:E36-45. [PMID: 25959859 PMCID: PMC4637260 DOI: 10.1111/bju.13179] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To evaluate long‐term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median (interquartile range) follow‐up of 12 (11–13) years. Patients and Methods In this nationwide, population‐based study, we identified 6 003 men diagnosed with localized prostate cancer (clinical local stage T1–2, any Gleason score, prostate‐specific antigen <20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 from the National Prostate Cancer Register, Sweden. The men were aged ≤70 years at diagnosis. A control group of 1 000 men without prostate cancer were also selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self‐reported questionnaire. Results Responses were obtained from 3 937/6 003 cases (66%) and 459/1 000 (46%) controls. At 12 years after diagnosis and at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction/sexual inactivity, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62, 6 and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction compared with the men in the control group. Radical prostatectomy was associated with an increased risk of urinary incontinence (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.36–2.62) and radiotherapy increased the risk of bowel dysfunction (OR 2.46, 95% CI 1.73–3.49) compared with men in the control group. Multi‐modal treatment, in particular treatment including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance, radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 (95% CI 1.76–7.95) for erectile dysfunction and an OR of 3.22 (95% CI 1.93–5.37) for urinary incontinence. Conclusion The proportion of men who experienced a long‐term impact on functional outcomes after prostate cancer treatment was substantial.
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Affiliation(s)
- Sigrid Carlsson
- Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | - Linda Drevin
- Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
| | - Stacy Loeb
- New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Anders Widmark
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - David Robinson
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.,Department of Urology, Ryhov County Hospital, Jönköping, Sweden
| | - Eva Johansson
- Department of Surgical Sciences, University Hospital of Uppsala, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
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19
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Sammon JD, Abdollah F, Klett DE, Pucheril D, Sood A, Trinh QD, Menon M. The diminishing returns of robotic diffusion: complications after robot-assisted radical prostatectomy. BJU Int 2015; 117:211-2. [DOI: 10.1111/bju.13111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jesse D. Sammon
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Firas Abdollah
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Dane E. Klett
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Daniel Pucheril
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Akshay Sood
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Quoc-Dien Trinh
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
- Center for Surgery and Public Health and Division of Urologic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Mani Menon
- VUI Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
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20
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Kim J, ElRayes W, Wilson F, Su D, Oleynikov D, Morien M, Chen LW. Disparities in the receipt of robot-assisted radical prostatectomy: between-hospital and within-hospital analysis using 2009-2011 California inpatient data. BMJ Open 2015; 5:e007409. [PMID: 25941184 PMCID: PMC4420943 DOI: 10.1136/bmjopen-2014-007409] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Despite the rapid proliferation of robot-assisted radical prostatectomy (RARP), little attention has been paid to patient utilisation of this newest surgical innovation and barriers that may result in disparities in access to RARP. The goal of this study is to identify demographic and economic factors that decrease the likelihood of patients with prostate cancer (PC) receiving RARP. DESIGN, SETTING AND PARTICIPANTS A retrospective, pooled, cross-sectional study was conducted using 2009-2011 California State Inpatient Data and American Hospital Association data. Patients who were diagnosed with PC and underwent radical prostatectomy (RP) from 225 hospitals in California were identified, using ICD-9-CM diagnosis and procedure codes. PRIMARY OUTCOME MEASURES Patients' likelihood of receiving RARP was associated with patient and hospital characteristics using the two models: (1) between-hospital and (2) within-hospital models. Multivariate binomial logistic regression was used for both models. The first model predicted patient access to RARP-performing hospitals versus non-RARP-performing hospitals, after adjusting for patient and hospital-level covariates (between-hospital variation). The second model examined the likelihood of patients receiving RARP within RARP-performing hospitals (within-hospital variation). RESULTS Among 20,411 patients who received RP, 13,750 (67.4%) received RARP, while 6661 (32.6%) received non-RARP. This study found significant differences in access to RARP-performing hospitals when race/ethnicity, income and insurance status were compared, after controlling for selected confounding factors (all p<0.001). For example, Hispanic, Medicare and Medicaid patients were more likely to be treated at non-RARP-performing hospitals versus RARP-performing hospitals. Within RARP-performing hospitals, Medicaid patients had 58% lower odds of receiving RARP versus non-RARP (adjusted OR 0.42, p<0.001). However, there were no significant differences by race/ethnicity or income within RARP-performing hospitals. CONCLUSIONS Significant differences exist by race/ethnicity and payer status in accessing RARP-performing hospitals. Furthermore, payer status continues to be an important predictor of receiving RARP within RARP-performing hospitals.
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Affiliation(s)
- Jungyoon Kim
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Wael ElRayes
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Fernando Wilson
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dejun Su
- Department of Health Promotion, Social and Behavioral Health, Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dmitry Oleynikov
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Marsha Morien
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Li-Wu Chen
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
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21
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Novara G, Ficarra V, Zattoni F, Fedeli U. Recourse to radical prostatectomy and associated short-term outcomes in Italy: a country-wide study over the last decade. BJU Int 2015; 116:862-7. [DOI: 10.1111/bju.13000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology; Urology Clinic; University of Padova; Padova Italy
| | - Vincenzo Ficarra
- Department of Experimental and Clinical Medical Sciences; Urologic Clinic; University of Udine; Udine Italy
| | - Filiberto Zattoni
- Department of Surgery, Oncology, and Gastroenterology; Urology Clinic; University of Padova; Padova Italy
| | - Ugo Fedeli
- Epidemiological Department; Veneto Region Italy
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Maurice MJ, Abouassaly R, Zhu H. American trends in expectant management utilization for prostate cancer from 2000 to 2009. Can Urol Assoc J 2014; 8:E775-82. [PMID: 25485003 DOI: 10.5489/cuaj.2073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTON The overtreatment of early prostate cancer has become a major public health concern. Expectant management (EM) is a strategy to minimize overtreatment, but little is known about its pattern of use. We sought to examine national EM utilization over the preceding decade. METHODS We examined prostate cancer treatment utilization from 2000 to 2009 using the National Cancer Database. EM use was analyzed in relation to other treatments and by cancer stage, age group, Charlson score, and hospital practice setting. RESULTS Overall, 109 997 (8.2%) men were managed initially with EM. EM usage remained stable at 7.6% to 9.5% from 2000 to 2009 with no appreciable increase for low-stage cancers. Usage was only slightly higher in elderly patients and in patients with multiple comorbidities. Veterans Affairs and low-volume hospitals had a much higher and increasing EM rate (range: 18.8%-29.8% and 15.1%-24.2%, respectively), compared to community hospitals, comprehensive cancer centres, and teaching hospitals, which showed no increased adoption. On further analysis, EM use remained high for low-stage cancers at Veterans Affairs and low-volume hospitals (24.0% and 19.1%, respectively), regardless of age or comorbidity, a pattern not shared by other practice settings. CONCLUSIONS EM utilization remained low and stable last decade, regardless of disease or patient characteristics. Conversely, Veterans Affairs and low-volume hospitals led the trend in national EM adoption, particularly in men with low-stage cancers and limited life expectancies. The limitations of this dataset preclude any determination of the appropriateness of EM utilization. Nonetheless, further study is needed to identify factors influencing EM adoption to ensure its proper use in the future.
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Affiliation(s)
- Matthew J Maurice
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Cleveland VA Medical Center; and Cleveland Clinic, Cleveland, OH
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23
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Segal RL, Camper SB, Burnett AL. Modern utilization of penile prosthesis surgery: a national claim registry analysis. Int J Impot Res 2014; 26:167-71. [DOI: 10.1038/ijir.2014.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/18/2014] [Accepted: 03/25/2014] [Indexed: 11/09/2022]
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