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Bandin A, Staff I, McLaughlin T, Tortora J, Pinto K, Negron R, Olivo Valentin L, Dinlenc C, Wagner J. Outcomes over 20 years performing robot-assisted laparoscopic prostatectomy: a single-surgeon experience. World J Urol 2023; 41:1047-1053. [PMID: 36930256 DOI: 10.1007/s00345-023-04346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To evaluate a single surgeon's 20-year experience with robotic radical prostatectomy. METHODS Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001-2005; cohort B 2006-2010; cohort C 2011-2015; cohort D 2016-2021) for analysis. Oncologic and quality of life outcomes were recorded at the time of follow-up visits. Continence was defined as 0-1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks. RESULTS Three thousand one hundred fifty-two patients met criteria for inclusion. Clavien ≥ 3 complication rates decreased from 5.9% to 3.2%, p = 0.021. There was considerable Gleason grade group (GG) and stage migration to more advanced disease between cohort A (6.4% GG4 or GG5, 16.2% pT3 or pT4, 1.2% N1) and cohort D (17% GG4 or GG5, 45.5% pT3 or pT4, 14.4% N1; p < 0.001). Consistent with this, an increasing proportion of patients required salvage treatments over time (14.6% of cohort A vs 22.5% of cohort D, p < 0.001). 1-year continence rates improved from 74.8% to greater than 92.4%, p < 0.001. While baseline potency and use of intraoperative nerve spare decreased, for patients potent at baseline, there were no significant differences for potency at one year (p = 0.065). CONCLUSIONS In this 20-year review of our experience with robotic prostatectomy, complication rates and continence outcomes improved over time, and there was a migration to more advanced disease at the time of surgery.
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Affiliation(s)
- Alexander Bandin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA.
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Kevin Pinto
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
| | - Rosa Negron
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Laura Olivo Valentin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
| | - Caner Dinlenc
- Department of Urology, Mount Sinai Beth Israel Medical Center, New York, NY, 10003, USA
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA
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An analysis of post-operative pain and narcotic use following robotic assisted laparoscopic prostatectomy for same day discharge. J Robot Surg 2023; 17:37-42. [PMID: 35294700 DOI: 10.1007/s11701-022-01386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/06/2022] [Indexed: 12/24/2022]
Abstract
Robotic assisted laparoscopic prostatectomy (RALP) has become the primary surgical modality in the treatment of prostate cancer. Most patients are discharged on postoperative day one. Same-day discharge is emerging as a potential new standard. We sought to establish factors correlating with post-operative pain after RALP procedures to design a same-day discharge protocol. We retrospectively reviewed 150 of recently performed RALP procedures from March 2020 to January 2021. Patient demographics and intra-operative variables were compared to Numeric Rating Scale (NRS) pain scores and total morphine milliequivalents (MME) at 2 h, 8 h, and averaged over the patient's admission post-operatively or first 48 h, whichever occurred first. We performed univariable and multivariable logistic regression to assess correlations with postoperative pain and narcotic use. NRS average > 3 or any MME given at 2 h postoperatively was significantly associated with continued post-operative pain averaged over admission (rs = 0.32, 0.38, respectively; p < 0.001). MME given was also associated with longer operative time and negative related to body mass index. No other demographic data or intraoperative variables such as diabetes or pneumoperitoneum pressure were correlated with worsened post-operative pain scores > 3 or narcotic use. Local bupivacaine dose was also not associated with improved post-operative pain scores or narcotic use at 8 h (p = 0.98, 0.13). These findings suggest that patients with adequate postoperative pain control at 2 hours may be discharged same day from a pain control perspective. Further clinical evaluation regarding the role of local anesthetic use in RALPs is warranted.
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Day EK, Galbraith NJ, Ward HJT, Roxburgh CS. Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review. J Robot Surg 2022; 17:811-826. [PMID: 36315379 DOI: 10.1007/s11701-022-01461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic-assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: "robot*", "surgery", "volume" and "outcome" was performed. The included procedures were gynecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, esophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983,149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Significant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.
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Affiliation(s)
- Elizabeth K Day
- Urology Department, University College London Hospital, Westmoreland Street, London, UK.
| | - Norman J Galbraith
- School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hester J T Ward
- Public Health Scotland, Gyle Square, Gyle Crescent, Edinburgh, UK
| | - Campbell S Roxburgh
- School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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4
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Impact of Hospital volume on postoperative outcomes after radical prostatectomy: A 5-Year nationwide database analysis. Eur Urol Focus 2022; 8:1169-1175. [PMID: 34147406 DOI: 10.1016/j.euf.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/05/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital volume is considered to be a quality measure for outcomes after major oncological surgery. However, countrywide data are lacking for radical prostatectomy (RP). OBJECTIVE To assess the impact of hospital volume on postoperative outcomes after RP performed using an open (ORP) versus a minimally invasive surgery (MIS, including pure and robot-assisted RP) approach. DESIGN, SETTING, AND PARTICIPANTS Data for patients undergoing RP in France from 2014 to 2019 were extracted from the central database of the national health care system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary endpoints were length of hospital stay (LOS), complications (measured as severity index [SI] scores), and hospital readmission rates at 30 and 90 d. RESULTS AND LIMITATIONS The median annual hospital volume was 19 RPs (interquartile range 1-40) in the overall cohort. MIS was associated with better outcomes than ORP. Greater hospital volume was correlated with shorter LOS (p < 0.001), high SI scores (SI3: p < 0.001; SI4: p < 0.001), and 30-d (p < 0.001) and 90-d readmission rates (p < 0.001). Incidence rates for SI3 and SI4 scores, and 30-d and 90-d readmission were 12.8 %, 5.8 %, 29.8 %, and 35.4 % in very low-volume centres (<10 annual cases) compared with 8.1 %, 1.9 %, 18.1 %, and 23.9 %, respectively, in other centres (all p < 0.001). Hospital volume was an independent risk factor for all outcomes after taking into account age, lymph node dissection, year of surgery, and surgical approach (ORP vs MIS). The main limitation is the lack of post-RP oncological and functional data. CONCLUSIONS This nationwide analysis of RP procedures shows a significant correlation between hospital volume and postoperative outcomes irrespective of the surgical approach. Very low case volume (<10 annual procedures per centre) is associated with the highest risk of complications, readmission, and prolonged LOS. Greater hospital volume is directly correlated with shorter LOS even beyond this threshold. PATIENT SUMMARY In this study we analysed the French nationwide database for removal of the prostate for prostate cancer. We found that the number of these cases that a hospital carries out per year was associated with outcomes after surgery, with better outcomes for higher annual case numbers.
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Balik M, Kosina J, Husek P, Pacovsky J, Brodak M, Cecka F. Can the prophylactic administration of tranexamic acid reduce the blood loss after robotic-assisted radical prostatectomy? Robotic Assisted Radical Prostatectomy with tranEXamic acid (RARPEX): study protocol for a randomized controlled trial. Trials 2022; 23:508. [PMID: 35717263 PMCID: PMC9206316 DOI: 10.1186/s13063-022-06447-x] [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: 07/18/2021] [Accepted: 06/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background The prophylactic administration of tranexamic acid reduces blood loss during procedures at high risk of perioperative bleeding. Several studies in cardiac surgery and orthopedics confirmed this finding. The aim of this prospective, double-blind, randomized study is to evaluate the effect of tranexamic acid on peri-and postoperative blood loss and on the incidence and severity of complications. Methods/design Based on the results of our pilot study, we decided to conduct this prospective, double-blind, randomized trial to confirm the preliminary data. The primary endpoint is to analyze the effect of tranexamic acid on perioperative and postoperative blood loss (decrease in hemoglobin levels) in robotic-assisted radical prostatectomy. The additional endpoint is to analyze the effect of tranexamic acid on postoperative complications and confirm the safety of tranexamic acid in robotic-assisted radical prostatectomy. Discussion No study to date has tested the prophylactic administration of tranexamic acid at the beginning of robotic-assisted radical prostatectomy. This study is designed to answer the question of whether the administration of tranexamic acid might lower the blood loss after the procedure or increase the rate and severity of complications. Trial registration ClinicalTrials.gov NCT04319614. Registered on 25 March 2020
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Affiliation(s)
- M Balik
- Department of Urology, Charles University, Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03, Hradec Kralove, Czech Republic
| | - J Kosina
- Department of Urology, Charles University, Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03, Hradec Kralove, Czech Republic
| | - P Husek
- Department of Urology, Charles University, Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03, Hradec Kralove, Czech Republic
| | - J Pacovsky
- Department of Urology, Charles University, Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03, Hradec Kralove, Czech Republic
| | - M Brodak
- Department of Urology, Charles University, Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03, Hradec Kralove, Czech Republic
| | - F Cecka
- Department of Surgery, Charles University, Faculty of Medicine in Hradec Králové, Šimkova 870, 500 03, Hradec Kralove, Czech Republic.
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6
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Labban M, Dasgupta P, Song C, Becker R, Li Y, Kreaden US, Trinh QD. Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK. JAMA Netw Open 2022; 5:e225740. [PMID: 35377424 PMCID: PMC8980901 DOI: 10.1001/jamanetworkopen.2022.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS). OBJECTIVE To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK. DESIGN, SETTING, AND PARTICIPANTS This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021. EXPOSURES Robotic-assisted radical prostatectomy, LRP, and ORP. MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs). RESULTS Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99. CONCLUSIONS AND RELEVANCE These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- MRC (Medical Research Council) Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Chao Song
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Atlanta, Georgia
| | | | - Yanli Li
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Sunnyvale, California
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, California
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Agochukwu-Mmonu N, Qi J, Dunn RL, Montie J, Wittmann D, Miller D, Martin R, Kim T, Johnston WK, Peabody J. Patient- and Surgeon-Level Variation in Patient-Reported Sexual Function Outcomes Following Radical Prostatectomy Over 2 Years: Results From a Statewide Surgical Improvement Collaborativep. JAMA Surg 2021; 157:136-144. [PMID: 34851369 DOI: 10.1001/jamasurg.2021.6215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Of patient-reported outcomes for individuals undergoing radical prostatectomy, sexual function outcomes are among the most reported and the most detrimental to quality of life. Understanding variations at the patient and surgeon level may inform collaborative quality improvement. Objective To describe patient- and surgeon-level sexual function outcomes for patients undergoing radical prostatectomy in the Michigan Urological Surgery Improvement Collaborative (MUSIC) and to examine the correlation between surgeon case volume and sexual function outcomes. Design, Setting, and Participants This is a prospective cohort study using the MUSIC registry and patient-reported sexual function outcome data. Patient- and surgeon-level variation in sexual function outcomes were examined among patients undergoing radical prostatectomy from May 2014 to August 2019. Sexual function outcome data were collected using validated questionnaires, which were completed before surgery and at 3, 6, 12, and 24 months' follow-up following surgery. All participants were male. Race and ethnicity data were self-reported and were included to examine potential variation in outcomes by race and/or ethnicity. Data were analyzed from January 2021 to March 2021. Main Outcomes and Measures There were 4 outcomes in this study, including the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) sexual function scores at 3, 6, 12, and 24 months' follow-up; patient-level sexual function recovery at 12- and 24-month follow-up; surgeon-level variation in sexual function outcomes at 12- and 24-month follow-up; and correlation between surgeon case volume and sexual function outcomes. Results A total of 1426 male patients met inclusion criteria for this study. The median (IQR) age was 64 (58-68) years. A total of 115 participants (8%) were Black, 1197 (84%) were White, 25 (2%) were of another race or ethnicity (consolidated owing to low numbers), and 89 (6%) were of unknown race or ethnicity. Among patients undergoing bilateral nerve-sparing radical prostatectomy, mean (SD) EPIC-26 sexual function scores at 12- and 24-month follow-up (12 months, 39 [28]; 24 months, 63 [29]) did not return to baseline levels. There was wide variation in EPIC-26 sexual function scores at both 12-month follow-up (range, 23-69; P < .001) and 24-month follow-up (range, 27-64; P < .001). Similar variations were found in EPIC-26 sexual function scores and recovery of sexual function by surgeon. Recovery rates ranged from 0% to 40% of patients at 12-month follow-up (18 surgeons; P < .001) and 3% to 44% of patients at 24-month follow-up (12 surgeons; P < .001). Surgeon case volume and sexual function outcomes were not significantly correlated. On multivariable analysis, the following variables were associated with better recovery at 24-month follow-up: younger age (P < .001), lower baseline EPIC-26 sexual function score (P < .001), lower Gleason score (P = .05), and nonobesity (P = .03). Conclusions and Relevance In this study, there was significant patient- and surgeon-level variation in sexual function recovery over 2 years following radical prostatectomy. Variation in surgeon-level sexual function outcomes presents an opportunity and model for surgical collaborative quality improvement.
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Affiliation(s)
- Nnenaya Agochukwu-Mmonu
- Department of Urology, New York University, New York.,Department of Population Health, New York University, New York
| | - Ji Qi
- Department of Urology, University of Michigan, Ann Arbor.,Dow Division of Health Services Research, University of Michigan, Ann Arbor
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor.,Dow Division of Health Services Research, University of Michigan, Ann Arbor
| | - James Montie
- Department of Urology, University of Michigan, Ann Arbor.,Dow Division of Health Services Research, University of Michigan, Ann Arbor
| | - Daniela Wittmann
- Department of Urology, University of Michigan, Ann Arbor.,Dow Division of Health Services Research, University of Michigan, Ann Arbor
| | - David Miller
- Department of Urology, University of Michigan, Ann Arbor.,Dow Division of Health Services Research, University of Michigan, Ann Arbor
| | - Rabia Martin
- Department of Urology, University of Michigan, Ann Arbor.,Dow Division of Health Services Research, University of Michigan, Ann Arbor
| | - Tae Kim
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor
| | - William K Johnston
- Department of Urology, Beaumont School of Medicine, Oakland University, Auburn Hills, Michigan
| | - James Peabody
- Department of Urology, Henry Ford Health System, Detroit, Michigan
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8
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Ploussard G, Grabia A, Barret E, Beauval JB, Brureau L, Créhange G, Dariane C, Fiard G, Fromont G, Gauthé M, Mathieu R, Renard-Penna R, Roubaud G, Ruffion A, Sargos P, Rouprêt M, Lequeu CE. Annual nationwide analysis of costs and post-operative outcomes after radical prostatectomy according to the surgical approach (open, laparoscopic, and robotic). World J Urol 2021; 40:419-425. [PMID: 34773475 DOI: 10.1007/s00345-021-03878-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Annual countrywide data are scarce when comparing surgical approaches in terms of hospital stay outcomes and costs for radical prostatectomy (RP). We aimed to assess the impact of surgical approach on post-operative outcomes and costs after RP by comparing open (ORP), laparoscopic (LRP), and robot-assisted (RARP) RP in the French healthcare system. PATIENTS AND METHODS Data from all patients undergoing RP in France in 2020 were extracted from the central database of the national healthcare system. Primary endpoints were length of hospital stay (LOS including intensive care unit (ICU) stay if present), complications (estimated by severity index), hospital readmission rates (at 30 and 90 days), and direct costs of initial stay. RESULTS AND LIMITATIONS A total of 19,018 RPs were performed consisting in ORP in 21.1%, LRP in 27.6%, and RARP in 51.3% of cases. RARP was associated with higher center volume (p < 0.001), lower complication rates (p < 0.001), shorter LOS (p < 0.001), and lower readmission rates (p = 0.004). RARP was associated with reduced direct stay costs (2286 euros) compared with ORP (4298 euros) and LRP (3101 euros). The main cost driver was length of stay. The main limitations were the lack of mid-term data, readmission details, and cost variations due to surgery system. CONCLUSIONS This nationwide analysis demonstrates the benefits of RARP in terms of post-operative short-term outcomes. Higher costs related to the robotic system appear to be balanced by patient care improvements and reduced direct costs due to shorter LOS.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, La Croix du Sud Hôpital, 52, Chemin de Ribaute, 31130, Quint Fonsegrives, France.
- IUCT-O, Toulouse, France.
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hôpital, 52, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, 97110, Pointe-à-Pitre, France
- Inserm, EHESP, Irset (Institut de Recherche en SantéEnvironnement et Travail)-UMR_S 1085, University of Rennes, Rennes, France
| | | | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris University-U1151 Inserm-INEM, Necker, Paris, France
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Mathieu Gauthé
- UMR 1153, Unité de Recherche Clinique en Économie de la Santé, CRESS METHODS INSERM, Paris, France
| | | | - Raphaële Renard-Penna
- AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, F-75013, Paris, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France
| | - Alain Ruffion
- Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Equipe 2-Centre d'Innovation en cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, Lyon, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000, Bordeaux, France
| | - Morgan Rouprêt
- AP-HP, Urology, GRC 5 Predictive Onco-Uro, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France
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9
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Balík M, Košina J, Hušek P, Broďák M, Čečka F. Safety and Efficacy of Using Tranexamic Acid at the Beginning of Robotic-Assisted Radical Prostatectomy in a Double-Blind Prospective Randomized Pilot Study. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 63:176-182. [PMID: 33355078 DOI: 10.14712/18059694.2020.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prophylactic administration of tranexamic acid has been shown to be appropriate for procedures with a high risk of perioperative bleeding in cardiac surgery and orthopaedics. In urology the ambiguous results have been reported. Our goal was to evaluate the effect of tranexamic acid administration in robotic-assisted radical prostatectomy (RARP). A pilot, prospective, double-blind, randomized study was conducted to evaluate this effect. METHODS The study included 100 patients who received RARP in the period from April 2017 to January 2018. The patients were randomly assigned to study and control groups of 50 patients each. RESULTS The median follow-up was 6 months. Lower haemoglobin level drop weighted for gram of operated prostate was observed in the study group when treating the dorsal vein complex (DVC) at the beginning of the procedure (p = 0.004 after 3 hours and p < 0.001 after 24 hours). There was no evidence of any serious side effect of tranexamic acid. CONCLUSION We demonstrated the safety of tranexamic acid at RARP. In addition, we showed that administration of tranexamic acid at the beginning of RARP significantly reduces the decrease in haemoglobin after the procedure when treating the DVC at the beginning of the procedure.
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Affiliation(s)
- Michal Balík
- Department of Urology, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic
| | - Josef Košina
- Department of Urology, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic
| | - Petr Hušek
- Department of Urology, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic
| | - Miloš Broďák
- Department of Urology, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic
| | - Filip Čečka
- Department of Surgery, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic.
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10
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Van den Broeck T, Oprea-Lager D, Moris L, Kailavasan M, Briers E, Cornford P, De Santis M, Gandaglia G, Gillessen Sommer S, Grummet JP, Grivas N, Lam TBL, Lardas M, Liew M, Mason M, O'Hanlon S, Pecanka J, Ploussard G, Rouviere O, Schoots IG, Tilki D, van den Bergh RCN, van der Poel H, Wiegel T, Willemse PP, Yuan CY, Mottet N. A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer. Eur Urol 2021; 80:531-545. [PMID: 33962808 DOI: 10.1016/j.eururo.2021.04.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown. OBJECTIVE To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa. EVIDENCE ACQUISITION Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed. EVIDENCE SYNTHESIS Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains. CONCLUSIONS Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed. PATIENT SUMMARY We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.
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Affiliation(s)
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, VU University, Amsterdam, The Netherlands
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Philip Cornford
- Department of Urology, Liverpool University Hospitals, Liverpool, UK
| | - Maria De Santis
- Department of Urology, Charité University Hospital, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silke Gillessen Sommer
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Australia
| | - Nikos Grivas
- Department of Urology, Hatzikosta General Hospital, Ioannina, Greece
| | - Thomas B L Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Matthew Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - Malcolm Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
| | | | | | - Olivier Rouviere
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôspital Edouard Herriot, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Centre, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul Willemse
- Department of Oncological Urology, University Medical Centre, Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Cathy Y Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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Cetin T, Yalcin MY, Karaca E, Ozbilen MH, Ergani B, Koc G, Boyacioglu H, Ilbey YO. Laparoscopic surgery experience does not influence oncological and functional results of robotic-assisted laparoscopic prostatectomy. Urologia 2021; 89:240-243. [PMID: 33764234 DOI: 10.1177/03915603211004781] [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: 11/17/2022]
Abstract
INTRODUCTION Surgery is one of the treatment alternatives for prostate cancer, and robotic-assisted laparoscopic prostatectomy (RALP) has become the new trend in the past decade. There is no consensus yet for surgeons who will perform RALP whether they need to be trained or experienced in laparoscopy. In this study, it was aimed to investigate the effectiveness of the surgeon's laparoscopy experience in the perioperative and postoperative results of RALP patients. MATERIAL AND METHOD Patients who underwent RALP were retrospectively screened. The first 20 cases done by surgeons in both groups and 40 cases in total were included in the study. Surgeons with laparoscopy training were designated as group 1, and surgeons without laparoscopy training were designated as group 2. Patient's age, preoperative prostate-specific antigen (PSA) value, prostate biopsy pathology, radical prostatectomy pathology, surgical margin positivity, extracapsular extension, and seminal vesicle invasion status, blood transfusion rate, operation time, length of hospital stay, and 1-year follow-up potency and urinary incontinence rates were compared. RESULTS There was no difference between the two groups in terms of age, preoperative PSA, preoperative biopsy results, blood transfusion rates, operation times, and the length of hospital stay of the patients. When the postoperative oncological and functional results of the patients were examined, there was no difference between the two groups in the prostatectomy pathology (p = 0.895), extracapsular extension (pT3a) (p = 0.519), positive surgical margin (pSM) (p = 0.723), and seminal vesicle invasion (pT3b) (p = 0.756). Potency and urinary incontinence rates were similar in both groups at the end of one year follow-up (p = 0.327, 0.500 respectively). CONCLUSIONS Based on our study, it is clearly seen that regardless of the surgeon's experience of laparoscopy, it can be safely preferred when looking at the oncological and functional results of RALP.
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Affiliation(s)
- Taha Cetin
- Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Erkin Karaca
- Izmir Tepecik Training and Research Hospital, Konak, Izmir, Turkey
| | | | | | - Gokhan Koc
- Izmir Tepecik Training and Research Hospital, Konak, Izmir, Turkey
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12
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Sachdev S, Carroll P, Sandler H, Nguyen PL, Wafford E, Auffenberg G, Schaeffer E, Roach M, Evans CP, Hussain M. Assessment of Postprostatectomy Radiotherapy as Adjuvant or Salvage Therapy in Patients With Prostate Cancer: A Systematic Review. JAMA Oncol 2020; 6:1793-1800. [PMID: 32852528 DOI: 10.1001/jamaoncol.2020.2832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance After radical prostatectomy, adverse pathologic features and postoperative prostate-specific antigen (PSA) levels can herald disease recurrence or progression. Postoperative radiotherapy (RT) remains beneficial in this setting. Objective To examine the evidence supporting the use of postoperative RT as well as recent advances that help determine timing, scope, and use in combination with androgen deprivation therapy (ADT) with or without lymphatic irradiation. Evidence Review A search was conducted of MEDLINE (Ovid), Embase (Elsevier), and the Cochrane Library (Wiley) databases, in addition to clinical trial registries. The reference list of included studies was reviewed for relevant articles. The search was limited to studies published between January 1, 2014, and December 31, 2019. Findings After 548 citations were screened, 27 articles were selected for inclusion. In addition to conventional imaging, positron-emission tomographic (PET)-based radiotracers can aid in disease localization. While PET imaging may influence management with RT, studies are underway examining this issue, and several limitations must be considered, such as limited detectability at lower PSA levels and regional sensitivity. Available genomic classifiers can risk stratify patients or assess potential added benefit of RT. Prospective validation is underway with cooperative group trials. Adjuvant RT, on the basis of adverse pathologic features (such as extraprostatic extension or positive margins) is beneficial in terms of disease control, but it is unclear whether this therapy translates into more meaningful clinical benefit (eg, improved overall survival and a reduction in metastasis), which has been demonstrated by only 1 older, prospective randomized study. Preliminary data suggest that for a relatively favorable-risk population (low Gleason score but with positive margins), PSA monitoring may be a reasonable alternative in some men. Use of androgen deprivation therapy and lymphatic irradiation should be considered in higher-risk cohorts (those with high PSA, high Gleason score, seminal vesicle invasion or node positivity) in conjunction with postoperative RT. Conclusions and Relevance The findings of this review suggest that postprostatectomy RT should be considered for men with prostate cancer in the setting of adverse pathologic features; in carefully selected patients with favorable characteristics, close PSA monitoring is an option. Androgen deprivation therapy and pelvic lymphatic irradiation should be considered for higher risk cohorts (eg, higher PSA values, higher Gleason score). PET imaging and molecular studies remain unproven as decision tools.
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Affiliation(s)
- Sean Sachdev
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Peter Carroll
- UCSF Hellen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco
| | - Howard Sandler
- Samuel Oschin Cancer Institute, Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paul L Nguyen
- Dana Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Cambridge, Illinois
| | - Eileen Wafford
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gregory Auffenberg
- Robert H. Lurie Comprehensive Cancer Center, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Edward Schaeffer
- Robert H. Lurie Comprehensive Cancer Center, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mack Roach
- UCSF Hellen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, University of California, San Francisco
| | - Christopher P Evans
- UC Davis Comprehensive Cancer Center, Department of Urologic Surgery, University of California, Davis, Sacramento
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Impact of surgical wait times during summer months on the oncological outcomes following robotic-assisted radical prostatectomy: 10 years' experience from a large Canadian academic center. World J Urol 2020; 39:2913-2919. [PMID: 33106941 DOI: 10.1007/s00345-020-03496-2] [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: 06/28/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Most Canadian hospitals face significant reductions in operating room access during the summer. We sought to assess the impact of longer wait times on the oncological outcomes of localized prostate cancer patients following robotic-assisted radical prostatectomy (RARP). METHODS We conducted a retrospective review of a prospectively maintained RARP database in two high-volume academic centers, between 2010 and 2019. Assessed outcomes included the difference between post-biopsy UCSF-CAPRA and post-surgical CAPRA-S scores, Gleason score upgrade and biochemical recurrence rates (BCR). Multivariable regression analyses (MVA) were used to evaluate the effect of wait times. RESULTS A total of 1057 men were included for analysis. Consistent over a 10 year period, summer months had the lowest surgical volumes despite above average booking volumes. The lowest surgical volume occurred during the month of July (7.1 cases on average), which was 35% less than the cohort average. The longest average wait times occurred for patients booked in June (93 ± 69 days, p < 0.001). On MVA, patients booked in June had significantly more chance of having an increase in CAPRA score [HR (95% CI) 1.64 (1.02-2.63); p = 0.04] and in CAPRA risk group [HR (95% CI) 1.82 (1.04-3.19); p = 0.03]. Cohort analysis showed fair correlation between CAPRA-score difference and wait time (Pearson correlation: r = - 0.062; p = 0.044). CONCLUSION Our cohort results demonstrate that conventional RARP wait times are significantly and consistently prolonged during summer months over the past 10 years, with worse post-RARP oncological outcomes in terms of CAPRA scores. Other compensatory mechanisms to sustain consistent yearly operative output should be considered.
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Abstract
Robotic surgery has been slow to be fully accepted in the world of pediatric urology largely because of its initial application directed towards adult use and because of the inherent high cost associated with it. However, as previously shown, it has now become the gold standard for adolescent pyeloplasty in The United States. As the adoption of robotic surgery in children has become more widespread, its use has been applied to a broader spectrum of procedures with similar success rates to standard laparoscopy. These procedures include nephrectomy, heminephrectomy, ureteral reimplantation, and ureteroureterostomy. However, it has also shown feasibility and comparable success when compared to open surgery in procedures that were previously deemed too complex to be done by standard laparoscopy. For example, bladder neck reconstruction with Mitrofanoff and Malone procedure as well as bladder augmentation. This review objective is to provide an overview of robotic surgery in pediatric urology, with a focus on the more common cases such as pyeloplasty and reimplantation as well as more complex bladder reconstruction procedures.
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15
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Ferrari M, Mazzola B, Roggero E, D'Antonio E, Mestre RP, Porcu G, Stoffel F, Renard J. Current evidence between hospital volume and perioperative outcome: Prospective assessment of robotic radical prostatectomy safety profile in a regional center of medium annual caseload. Can Urol Assoc J 2020; 15:E153-E159. [PMID: 32807280 DOI: 10.5489/cuaj.6547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to present the safety profile of robotic radical prostatectomy (RARP) performed in a single center of medium surgical volume since its introduction and identify predictors of postoperative complications. METHODS We prospectively collected clinical data from 317 consecutive patients undergoing RARP between August 2011 and November 2019 in a medium-volume center. Surgical procedures were performed by a single experienced surgeon. Complications were collected according to the Martin criteria for reporting and the Clavien-Dindo classification for rating. Preoperative, intraoperative, and postoperative data were analyzed and compared with available literature. RESULTS A total of 102 complications were observed in 96 (30.3%) patients and were minor in 84.4% of cases (Clavien grade 1 and 2). Transfusion rate was 1.3%. Complications of grade 4b or 5 did not occur. The most frequent complications were urinary retention (7.3%) and anastomotic leak (5.9%). At multivariate analysis, the nerve-sparing technique was an independent predictor of complications (odds ratio [OR] 0.55, p=0.02). CONCLUSIONS The study shows that a high safety profile may be achieved in a medium-volume hospital. The nerve-sparing technique was a predictor of complications. Further studies are needed to define the current relationship between surgical volume and perioperative outcome for RARP.
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Affiliation(s)
- Matteo Ferrari
- Division of Urology, Bellinzona Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Brunello Mazzola
- Division of Urology, Bellinzona Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Enrico Roggero
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Eugenia D'Antonio
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Ricardo Pereira Mestre
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Giovanni Porcu
- Division of Urology, Bellinzona Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Flavio Stoffel
- Division of Urology, Bellinzona Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Julien Renard
- Division of Urology, Bellinzona Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Division of Urology, Geneva University Hospitals, Geneva, Switzerland
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Nabi J, Friedlander DF, Chen X, Cole AP, Hu JC, Kibel AS, Dasgupta P, Trinh QD. Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults. JAMA Netw Open 2020; 3:e1919185. [PMID: 31940036 PMCID: PMC6991257 DOI: 10.1001/jamanetworkopen.2019.19185] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative outcomes and costs, differences in out-of-pocket costs for patients undergoing robotic surgery are not well understood. OBJECTIVE To assess out-of-pocket costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional, propensity score-weighted analysis was performed using deidentified insurance claims for 1.9 million enrollees from the MarketScan database from January 1, 2012, to December 31, 2017. The final study sample comprised 15 893 US adults aged 18 to 64 years who were enrolled in an employer-sponsored health plan. Patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm. Statistical analysis was performed from December 18, 2018, to June 5, 2019. EXPOSURES Type of surgical procedure-robotic vs open. MAIN OUTCOMES AND MEASURES The primary outcome of interest was out-of-pocket costs associated with robotic and open surgery. The secondary outcome of interest was associated total payments. RESULTS Among 15 893 patients (11 102 men; mean [SD] age, 55.4 [6.6] years), 8260 underwent robotic and 7633 underwent open procedures; patients undergoing robotic hysterectomy were older than those undergoing open hysterectomy (mean [SD] age, 55.7 [6.7] vs 54.6 [7.2] years), and patients undergoing open radical nephrectomy had more comorbidities than those undergoing robotic radical nephrectomy (≥2 comorbidities, 658 of 861 [76.4%] vs 244 of 347 [70.3%]). After adjustment for baseline characteristics, the robotic approach was associated with lower out-of-pocket costs for all procedures: -$137.75 (95% CI, -$240.24 to -$38.63) for radical prostatectomy (P = .006); -$640.63 (95% CI, -$933.62 to -$368.79) for hysterectomy (P < .001); -$1140.54 (95% CI, -$1397.79 to -$896.54) for partial colectomy (P < .001); -$728.32 (95% CI, -$1126.90 to -$366.08) for radical nephrectomy (P < .001); and -$302.74 (95% CI, -$523.14 to -$97.10) for partial nephrectomy (P = .003). The robotic approach was similarly associated with lower adjusted total payments: -$3872.62 (95% CI, -$5385.49 to -$2399.04) for radical prostatectomy (P < .001); -$29 640.69 (95% CI, -$36 243.82 to -$23 465.94) for hysterectomy (P < .001); -$38 151.74 (95% CI, -$46 386.16 to -$30 346.22) for partial colectomy; (P < .001); -$33 394.15 (95% CI, -$42 603.03 to -$24 955.20) for radical nephrectomy (P < .001); and -$9162.52 (95% CI, -$12 728.33 to -$5781.99) for partial nephrectomy (P < .001). CONCLUSIONS AND RELEVANCE This study found significant variation in perioperative costs according to surgical technique for both patients (out-of-pocket costs) and payers (total payments); the robotic approach was associated with lower out-of-pocket costs for all studied oncologic procedures.
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Affiliation(s)
- Junaid Nabi
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David F. Friedlander
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xi Chen
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P. Cole
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Adam S. Kibel
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- Medical Research Council Centre for Transplantation, National Institute for Health Research Biomedical Research Centre, King’s College, London, United Kingdom
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Richards CR, Steele SR, Lustik MB, Gillern SM, Lim RB, Brady JT, Althans AR, Schlussel AT. Safe surgery in the elderly: A review of outcomes following robotic proctectomy from the Nationwide Inpatient Sample in a cross-sectional study. Ann Med Surg (Lond) 2019; 44:39-45. [PMID: 31312442 PMCID: PMC6610645 DOI: 10.1016/j.amsu.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background As our nation's population ages, operating on older and sicker patients occurs more frequently. Robotic operations have been thought to bridge the gap between a laparoscopic and an open approach, especially in more complex cases like proctectomy. Methods Our objective was to evaluate the use and outcomes of robotic proctectomy compared to open and laparoscopic approaches for rectal cancer in the elderly. A retrospective cross-sectional cohort study utilizing the Nationwide Inpatient Sample (NIS; 2006-2013) was performed. All cases were restricted to age 70 years old or greater. Results We identified 6740 admissions for rectal cancer including: 5879 open, 666 laparoscopic, and 195 robotic procedures. The median age was 77 years old. The incidence of a robotic proctectomy increased by 39%, while the open approach declined by 6% over the time period studied. Median (interquartile range) length of stay was shorter for robotic procedures at 4.3 (3-7) days, compared to laparoscopic 5.8 (4-8) and open at 6.7 (5-10) days (p < 0.01), while median total hospital charges were greater in the robotic group compared to laparoscopic and open cases ($64,743 vs. $55,813 vs. $50,355, respectively, p < 0.01). There was no significant difference in the risk of total complications between the different approaches following multivariate analysis. Conclusion Robotic proctectomy was associated with a shorter LOS, and this may act as a surrogate marker for an overall improvement in adverse events. These results demonstrate that a robotic approach is a safe and feasible option, and should not be discounted solely based on age or comorbidities.
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Affiliation(s)
- Carly R. Richards
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI, United States
- Corresponding author. 1 Jarrett White Road, Honolulu, HI, 96859, United States.
| | - Scott R. Steele
- Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Michael B. Lustik
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, HI, United States
| | - Suzanne M. Gillern
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI, United States
| | - Robert B. Lim
- Department of Surgery, Tripler Army Medical Center, Honolulu, HI, United States
| | - Justin T. Brady
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, United States
| | - Ali R. Althans
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, United States
| | - Andrew T. Schlussel
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA, United States
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Preisser F, Pompe RS, Salomon G, Rosenbaum C, Graefen M, Huland H, Karakiewicz PI, Tilki D. Impact of the estimated blood loss during radical prostatectomy on functional outcomes. Urol Oncol 2019; 37:298.e11-298.e17. [DOI: 10.1016/j.urolonc.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/11/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
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Joice GA, Chappidi MR, Patel HD, Kates M, Sopko NA, Stimson CJ, Pierorazio PM, Bivalacqua TJ. Hospitalisation and readmission costs after radical cystectomy in a nationally representative sample: does urinary reconstruction matter? BJU Int 2018; 122:1016-1024. [PMID: 29897156 DOI: 10.1111/bju.14448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the impact of continent urinary diversion on readmissions and hospital costs in a nationally representative sample of radical cystectomies (RCs) performed in the USA. PATIENTS AND METHODS The 2010-2014 Nationwide Readmissions Database was queried for patients with a diagnosis of bladder cancer who underwent RC. We identified patients undergoing continent (neobladder or continent cutaneous reservoir) or incontinent (ileal conduit) diversions. Multivariable logistic regression models were used to identify predictors of 90-day readmission, prolonged length of stay, and total hospital costs. RESULTS Amongst 21 126 patients identified, 19 437 (92.0%) underwent incontinent diversion and 1 689 (8.0%) had a continent diversion created. Continent diversion patients were younger, healthier, and treated at high-volume metropolitan centres. Continent diversions resulted in fewer in-hospital complications (37.3% vs 42.5%, P = 0.02) but led to more 90-day readmissions (46.5% vs 39.6%, P = 0.004). In addition, continent diversion patients were more often readmitted for infectious complications (38.7% vs 29.4%, P = 0.004) and genitourinary complications (18.5% vs 13.0%, P = 0.01). On multivariable logistic regression, patients with a continent diversion were more likely to be readmitted within 90 days (odds ratio [OR] 1.55, 95% confidence interval [CI]: 1.28, 1.88) and have increased hospital costs during initial hospitalisation (OR 1.99, 95% CI: 1.52, 2.61). Continent diversion led to a $4 617 (American dollars) increase in initial hospital costs ($36 640 vs $32 023, P < 0.001), which was maintained at 30 days ($48 621 vs $44 231, P < 0.001) and at 90 days ($56 380 vs $52 820, P < 0.001). CONCLUSION In a nationally representative sample of RCs performed in the USA, continent urinary diversion led to more frequent readmissions and increased hospital costs. Interventions designed to address specific outpatient issues with continent diversions can potentially lead to a significant decrease in readmissions and associated hospital costs.
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Affiliation(s)
- Gregory A Joice
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meera R Chappidi
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hiten D Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Max Kates
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nikolai A Sopko
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C J Stimson
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Schaumeier MJ, Hawkins AT, Hevelone ND, Sethi RKV, Nguyen LL. Association of Treatment for Critical Limb Ischemia with Gender and Hospital Volume. Am Surg 2018. [DOI: 10.1177/000313481808400668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Critical limb ischemia (CLI) is a frequent and major vascular problem and can lead to amputation and death despite surgical revascularization. Women have been shown to have 3 to 4 per cent lower revascularization rates for CLI compared with men as well as inferior outcomes. We hypothesize that this difference is a result of women being more likely admitted to low-volume hospitals, which in turn perform fewer revascularizations. Prospective cohort study. Data from the Nationwide Inpatient Sample 2007 to 2010 were used to identify admissions with primary International Classification of Diseases-9 codes for CLI (International Classification of Diseases-9 codes: 440.22, 440.23, 440.24, 707.1, 707.10–707.15, or 707.19). Hospitals were grouped in quintiles by annual revascularization procedures. Bivariate analyses were performed and multivariable logistic regression was used to analyze the odds of revascularization, amputation, and mortality while controlling for patient and hospital-level factors. Of 113,631 admissions, 54,370 (47.8%) were women, who were more likely admitted to low-volume hospitals (very low: 49.6% vs very high: 47.1%; P < 0.001). Revascularization rates were lower in women (31.6% vs 35.1%, P < 0.001) across all volume quintiles, whereas the difference was greatest in the use of open surgical revascularization (12.5% vs 16.0%, P < 0.001). In multivariable analysis, female gender [odds ratio (OR) 0.87, 95% confidence interval (CI) 0.83–0.92, P < 0.001] and very-low hospital volume (OR 0.21, 95% CI 0.17–0.26, P < 0.001) were both significantly associated with lower rates of revascularization. Women had lower odds of major amputation compared with men (OR 0.75, 95% CI 0.69–0.82, P < 0.001), whereas treatment in a very high-volume hospital was associated with increased odds for amputation (OR 1.37, 95% CI 1.09–1.73, P = 0.008). Neither gender nor hospital volume were independently associated with in-hospital mortality in the multivariable regression model. Women are more likely to be admitted to low-volume hospitals for treatment of CLI. Because of this, they are less likely to undergo revascularization, although they also had lower rates of major amputation.
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Affiliation(s)
- Maria J. Schaumeier
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander T. Hawkins
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nathanael D. Hevelone
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Louis L. Nguyen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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21
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Cole AP, Friedlander DF, Trinh QD. Secondary data sources for health services research in urologic oncology. Urol Oncol 2018; 36:165-173. [DOI: 10.1016/j.urolonc.2017.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 12/15/2022]
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22
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Flavin K, Prasad V, Gowrie-Mohan S, Vasdev N. Renal Physiology and Robotic Urological Surgery. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of robotic-assisted laparoscopic techniques has transformed the face of urological surgery in the last decade, with demonstrable benefits over both unassisted laparoscopic and traditional open approaches. For example, robotic-assisted partial nephrectomy is associated with lower morbidity, improved convalescence, reduced postoperative pain, shorter length of hospital stay, and a superior cosmetic result when compared to an open procedure. This review discusses the various perioperative influences on the renal physiology of patients undergoing robotic-assisted urological procedures.
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Affiliation(s)
- Kate Flavin
- Department of Anaesthetics, Lister Hospital, Hertfordshire, UK
| | - Venkat Prasad
- Department of Anaesthetics, Lister Hospital, Hertfordshire, UK
| | | | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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23
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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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24
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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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25
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Cadeddu JA. Re: Robot-Assisted versus Open Radical Prostatectomy: A Contemporary Analysis of an All-Payer Discharge Database. J Urol 2017; 197:1458. [PMID: 28505902 DOI: 10.1016/j.juro.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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26
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Vetterlein MW, Löppenberg B, Karabon P, Dalela D, Jindal T, Sood A, Chun FKH, Trinh QD, Menon M, Abdollah F. Impact of travel distance to the treatment facility on overall mortality in US patients with prostate cancer. Cancer 2017; 123:3241-3252. [DOI: 10.1002/cncr.30744] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/09/2017] [Accepted: 03/29/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Malte W. Vetterlein
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
- Division of Urological Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Björn Löppenberg
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
- Division of Urological Surgery and 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
| | - Patrick Karabon
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
- Department of Public Health Sciences; Henry Ford Health System; Detroit Michigan
| | - Deepansh Dalela
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Tarun Jindal
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Akshay Sood
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Felix K.-H. Chun
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mani Menon
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Firas Abdollah
- Center for Outcomes Research; Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
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27
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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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28
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Naik G, Akinyemiju T. Disparities in hospitalization outcomes among African-American and White prostate cancer patients. Cancer Epidemiol 2017; 46:73-79. [PMID: 28056390 DOI: 10.1016/j.canep.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This paper aims to determine whether racial disparities exist in hospitalization outcomes among African-American and White hospitalized prostate cancer patients in the United States. We evaluated racial differences among matched groups of patients in post-operative complications, hospital length of stay and in-hospital mortality. METHODS We identified a total of 183,856 men aged 40 years and older with a primary diagnosis of prostate cancer, of which 58,701 underwent prostatectomy, through the Nationwide Inpatient Sample, and matched all African-American patients with White patients on: 1) Demographics, 2) Demographics+Clinical presentation and 3) Demographics+Clinical presentation+Treatment. Multivariable regression analyses were conducted in SAS and estimates were reported with 95% confidence intervals. RESULTS African-American patients were more likely to be admitted with metastatic disease (24.8%) compared with White patients matched on demographics (17.9%), and demographics+presentation (23.6%). However, 23.9% of African-American patients received surgery compared with 38.2% and 34.2% of Whites matched on demographics and demographics+presentation, respectively. White patients had lower in-hospital mortality compared with African-American patients matched on demographics (OR: 0.72, 95% CI: 0.66-0.79), demographics+presentation (OR: 0.88, 95% CI: 0.81-0.96), but was no longer significantly lower when matched on demographics, presentation and treatment (OR: 0.92, 95% CI: 0.85-1.00). CONCLUSION There were significant racial differences in outcomes among prostate cancer patients within the inpatient setting, even after accounting for demographic and presentation differences.
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Affiliation(s)
- Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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29
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Taneja SS. Re: Robot-Assisted Laparoscopic Prostatectomy versus Open Radical Retropubic Prostatectomy: Early Outcomes from a Randomised Controlled Phase 3 Study. J Urol 2016; 197:151. [PMID: 27979507 DOI: 10.1016/j.juro.2016.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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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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Cole AP, Leow JJ, Chang SL, Chung BI, Meyer CP, Kibel AS, Menon M, Nguyen PL, Choueiri TK, Reznor G, Lipsitz SR, Sammon JD, Sun M, Trinh QD. Surgeon and Hospital Level Variation in the Costs of Robot-Assisted Radical Prostatectomy. J Urol 2016; 196:1090-5. [PMID: 27157376 DOI: 10.1016/j.juro.2016.04.087] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE We assessed surgeon and hospital level variation in robot-assisted radical prostatectomy costs and predictors of high and low cost surgery. MATERIALS AND METHODS The study population consisted of a weighted sample of 291,015 men who underwent robot-assisted radical prostatectomy for prostate cancer by 667 surgeons at 197 U.S. hospitals from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 USD) in the Premier Hospital Database. High costs per robot-assisted radical prostatectomy were those above the 90th percentile and low costs were those below the 10th percentile. RESULTS Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group. Nearly a third of the variation in robot-assisted radical prostatectomy cost was attributable to hospital characteristics and more than a fifth was attributable to surgeon characteristics (R-squared 30.43% and 21.25%, respectively). High volume surgeons and hospitals (90th percentile or greater) had decreased odds of high cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105, 95% CI 0.02-0.46). The performance of robot-assisted radical prostatectomy at a high volume hospital was associated with increased odds of low cost robot-assisted radical prostatectomy (OR 839, 95% CI 122-greater than 999). CONCLUSIONS This study provides insight into the role of surgeons and hospitals in robot-assisted radical prostatectomy costs. Given the substantial variability, identifying and remedying the root cause of outlier costs may yield substantial benefits.
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Affiliation(s)
- Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Christian P Meyer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Gally Reznor
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Maxine Sun
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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32
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Jackson MA, Bellas N, Siegrist T, Haddock P, Staff I, Laudone V, Wagner JR. Experienced Open vs Early Robotic-assisted Laparoscopic Radical Prostatectomy: A 10-year Prospective and Retrospective Comparison. Urology 2016; 91:111-8. [DOI: 10.1016/j.urology.2015.12.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/04/2015] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
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33
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Chen YW, Mahal BA, Muralidhar V, Nezolosky M, Beard CJ, Den RB, Feng FY, Hoffman KE, Martin NE, Orio PF, Nguyen PL. Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2016; 94:683-90. [DOI: 10.1016/j.ijrobp.2015.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/22/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
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34
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The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. Urol Oncol 2016; 34:121.e15-21. [DOI: 10.1016/j.urolonc.2015.09.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/13/2015] [Accepted: 09/16/2015] [Indexed: 11/18/2022]
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35
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Björklund J, Folkvaljon Y, Cole A, Carlsson S, Robinson D, Loeb S, Stattin P, Akre O. Postoperative mortality 90 days after robot-assisted laparoscopic prostatectomy and retropubic radical prostatectomy: a nationwide population-based study. BJU Int 2016; 118:302-6. [PMID: 26762928 DOI: 10.1111/bju.13404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess 90-day postoperative mortality after robot-assisted laparoscopic radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) using nationwide population-based registry data. PATIENTS AND METHODS We conducted a cohort study using the National Prostate Cancer Register of Sweden, including 22 344 men with localized prostate cancer of clinical stage T1-T3, whose prostate-specific antigen levels were <50 μg/mL and who had undergone primary radical prostatectomy in the period 1998-2012. Vital status was ascertained through the Total Population Register. The rates for 90-day postoperative mortality were analysed using logistic regression analysis, and comparisons of 90-day mortality with the background population were made using standardized mortality ratios (SMRs). RESULTS Of the 14 820 men who underwent RRP, 29 (0.20%) died, and of the 7 524 men who underwent RARP, 10 (0.13%) died. Mortality in the cohort during the 90-day postoperative period was lower than in an age-matched background population: SMR 0.57 (95% confidence interval [CI] 0.39-0.75). There was no statistically significant difference in 90-day mortality according to surgical method: RARP vs RRP odds ratio (OR) 1.14; 95% CI 0.46-2.81. Postoperative 90-day mortality decreased over time: 2008-2012 vs 1998-2007 OR 0.44; 95% CI 0.21-0.95, mainly because of lower mortality after RARP. CONCLUSION The 90-day postoperative mortality rates were low after RARP and RRP and there was no statistically significant difference between the methods. Given the long life expectancy among men with low- and intermediate-risk prostate cancer, very low postoperative mortality is a prerequisite for RP, which was fulfilled by both RRP and RARP. The selection of healthy men for RP is highlighted by the lower 90-day mortality after RP compared with the background population.
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Affiliation(s)
- Johan Björklund
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Yasin Folkvaljon
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Alexander Cole
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Carlsson
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - David Robinson
- Department of Urology, Ryhov County Hospital, Jönköping, Sweden.,Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Stacy Loeb
- Department of Urology Population Health, the Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA
| | - Pär Stattin
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Olof Akre
- Department of Urology, Karolinska University Hospital, Solna, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Leow JJ, Chang SL, Meyer CP, Wang Y, Hanske J, Sammon JD, Cole AP, Preston MA, Dasgupta P, Menon M, Chung BI, Trinh QD. Robot-assisted Versus Open Radical Prostatectomy: A Contemporary Analysis of an All-payer Discharge Database. Eur Urol 2016; 70:837-845. [PMID: 26874806 DOI: 10.1016/j.eururo.2016.01.044] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy. OBJECTIVE To compare outcomes and costs between RARP and open RP (ORP). DESIGN, SETTING, AND PARTICIPANTS A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database. INTERVENTION RARP was ascertained through a review of the hospital charge description master for robotic supplies. OUTCOME MEASURES AND STATISTICAL ANALYSIS Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates. RESULTS AND LIMITATIONS RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study. CONCLUSIONS Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP. PATIENT SUMMARY In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.
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Affiliation(s)
- Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian P Meyer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian Hanske
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Jesse D Sammon
- VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prokar Dasgupta
- Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, UK
| | - Mani Menon
- VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Mahida JB, Cooper JN, Herz D, Diefenbach KA, Deans KJ, Minneci PC, McLeod DJ. Utilization and costs associated with robotic surgery in children. J Surg Res 2015; 199:169-76. [DOI: 10.1016/j.jss.2015.04.087] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/12/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
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Agarwal G, Valderrama O, Luchey AM, Pow-Sang JM. Robotic-Assisted Laparoscopic Radical Prostatectomy. Cancer Control 2015; 22:283-90. [DOI: 10.1177/107327481502200305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Oscar Valderrama
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Adam M. Luchey
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M. Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Herkommer K, Schmid SC, Schulwitz H, Dinkel A, Klorek T, Hofer C, Ehrl D, Blaser R, Gschwend JE, Kron M. Health-related quality of life after radical prostatectomy depends on patient׳s age but not on comorbidities. Urol Oncol 2015; 33:266.e1-7. [DOI: 10.1016/j.urolonc.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 02/11/2015] [Accepted: 03/04/2015] [Indexed: 11/25/2022]
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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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Stolzenburg JU, Graefen M, Kriegel C, Michl U, Martin Morales A, Pommerville PJ, Manning M, Büttner H, Henneges C, Schostak M. Effect of surgical approach on erectile function recovery following bilateral nerve-sparing radical prostatectomy: an evaluation utilising data from a randomised, double-blind, double-dummy multicentre trial of tadalafil vs placebo. BJU Int 2015; 116:241-51. [DOI: 10.1111/bju.13030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | - Uwe Michl
- Martini Hospital, UKE GmbH; Hamburg Germany
| | | | - Peter J. Pommerville
- Department of Urological Sciences; University of British Columbia; Victoria BC Canada
| | | | | | | | - Martin Schostak
- Department of Urology and Paediatric Urology; Magdeburg University Medical Centre; Magdeburg Germany
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Khan R, Aydin A, Khan MS, Dasgupta P, Ahmed K. Simulation-based training for prostate surgery. BJU Int 2015; 116:665-74. [DOI: 10.1111/bju.12721] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Raheej Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
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Lott FM, Favorito LA. Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer. Acta Cir Bras 2015; 30:229-34. [DOI: 10.1590/s0102-8650201500300000011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/18/2015] [Indexed: 11/22/2022] Open
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Taneja SS. Re: Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination Era. J Urol 2014. [DOI: 10.1016/j.juro.2014.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trudeau V, Gandaglia G, Shiffmann J, Popa I, Shariat SF, Montorsi F, Perrotte P, Trinh QD, Karakiewicz PI, Sun M. Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: A population-based assessment of costs and perioperative outcomes. Can Urol Assoc J 2014; 8:E695-701. [PMID: 25408809 DOI: 10.5489/cuaj.2051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large population-based cohort of patients with upper-tract urothelial carcinoma (UTUC). METHODS Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. RESULTS Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. CONCLUSIONS Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU.
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Affiliation(s)
- Vincent Trudeau
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
| | - Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; ; Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
| | - Jonas Shiffmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; ; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ioana Popa
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
| | | | - Francesco Montorsi
- Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
| | - Paul Perrotte
- Department of Urology, University of Montreal Health Centre, Montreal, QC
| | - Quoc-Dien Trinh
- Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; ; Department of Urology, University of Montreal Health Centre, Montreal, QC
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
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Costalonga EC, Costa e Silva VT, Caires R, Hung J, Yu L, Burdmann EA. Prostatic surgery associated acute kidney injury. World J Nephrol 2014; 3:198-209. [PMID: 25374813 PMCID: PMC4220352 DOI: 10.5527/wjn.v3.i4.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/07/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Acute kidney injury (AKI) is associated with extended hospital stays, high risks of in-hospital and long-term mortality, and increased risk of incident and progressive chronic kidney disease. Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy, older age, and preexistent chronic kidney disease. Nonetheless, precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking. Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures. Whereas severe AKI after prostate surgery in general appears to be unusual, AKI associated with transurethral resection of the prostate (TURP) syndrome and with rhabdomyolysis (RM) after radical prostatectomy have been frequently described. The purpose of this review is to discuss the current knowledge regarding the epidemiology, risk factors, outcomes, prevention, and treatment of AKI associated with prostatic surgery. The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.
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Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis. Indian J Surg 2014; 77:1326-33. [PMID: 27011560 DOI: 10.1007/s12262-014-1170-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022] Open
Abstract
Open retropubic radical prostatectomy (ORP) remains the "gold standard" for surgical treatment of clinically localized prostate cancer (PCa). Robot-assisted radical prostatectomy (RARP) is a robotic surgery used worldwide. The aim of this study is to collect the data available in the literature on RARP and ORP, and further evaluate the overall safety and efficacy of RARP vs. ORP for the treatment of clinically localized PCa. A literature search was performed using electronic databases between January 2009 and October 2013. Clinical data such as operation duration, transfusion rate, positive surgical margins (PSM), nerve sparing, 3- and 12-month urinary continence, and potency were pooled to carry out meta-analysis. Six studies were enrolled for this meta-analysis. The operation duration of RARP group was longer than that of ORP group (weighted mean difference = 64.84). There was no statistically significant difference in the transfusion rate, PSM rate, and between RARP and ORP (transfusion rate, OR = 0.30; PSM rate, OR = 0.94). No significant difference was seen in 3- and 12-month urinary continence recovery (3 months, OR = 1.32; 12 months, OR = 1.30). There was a statistically significant difference in potency between the 3- and 12-month groups (3 months, OR = 2.80; 12 months, OR = 1.70). RARP is a safe and feasible surgical technique for the treatment of clinically localized PCa owing to the advantages of fewer perioperative complications and quicker patency recovery.
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Cohen S, Palazzi K, Marietti S, Kaplan G, Chiang G. Lack of improvement: a national assessment of readmission rates after pediatric bladder reconstruction. Nephrourol Mon 2014; 6:e20263. [PMID: 25695034 PMCID: PMC4318081 DOI: 10.5812/numonthly.20263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/14/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Bladder reconstruction in the pediatric population is challenging for many reasons, including perioperative complications and readmissions. Objectives: On a national scale, determine readmission rates at 30, 60 and 90 days after bladder reconstruction in a pediatric population over a 7-year period, evaluating the influence of hospital and patient-specific variables. Patients and Methods: Using the Pediatric Health Information System database, we identified patients 0-17 years of age, from 2004-2010, undergoing bladder reconstruction using ICD-9 procedure codes. Descriptive statistics characterized demographics, prevalence of surgeries, and readmission rates. Surgery prevalence over time was examined using linear regression. Readmission rates were compared using the Chi2 test. Regression was used to evaluate the influence of variables on readmission risk. Results: We identified 1,985 patients for inclusion, of which 52.7% were female. Median age was 9 years. There has been no change in the prevalence of bladder reconstruction surgeries (P = 0.327). There was no change in 30-day (P = 0.272), 60-day (P = 0.788) or 90-day readmission rates (P = 0.924). Despite surgical volume adjustment, 90-day readmission rates did not significantly vary among the majority of hospitals. Initial LOS > 7 days (P < 0.001) and complex chronic condition males (P < 0.001) were significantly associated with 90-day readmission. Conclusions: No improvement in readmission rates after pediatric bladder reconstruction was observed during the study period. Nearly all centers have a similar readmission rate despite volume adjustment.
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Affiliation(s)
- Seth Cohen
- Department of Urology, UC San Diego Health System, University of California, San Diego, USA
| | - Kerrin Palazzi
- Pediatric Urology, Rady Children’s Hospital-San Diego, University of California, San Diego, USA
| | - Sarah Marietti
- Department of Urology, UC San Diego Health System, University of California, San Diego, USA
- Pediatric Urology, Rady Children’s Hospital-San Diego, University of California, San Diego, USA
| | - George Kaplan
- Department of Urology, UC San Diego Health System, University of California, San Diego, USA
- Pediatric Urology, Rady Children’s Hospital-San Diego, University of California, San Diego, USA
| | - George Chiang
- Department of Urology, UC San Diego Health System, University of California, San Diego, USA
- Pediatric Urology, Rady Children’s Hospital-San Diego, University of California, San Diego, USA
- Corresponding author: George Chiang, Department of Urology, UC San Diego Health System, University of California, San Diego, USA. Tel: +1-8589665922, Fax: +1-8589668479, E-mail:
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Chughtai B, Isaacs AJ, Mao J, Lee R, Te A, Kaplan S, Sedrakyan A. Safety of robotic prostatectomy over time: a national study of in-hospital injury. J Endourol 2014; 29:181-5. [PMID: 25026363 DOI: 10.1089/end.2014.0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess national trends of iatrogenic complications and associated burden of care among patients undergoing open and minimally invasive prostatectomy using a population-based cohort. METHODS Using the nationally representative cohort, we identified patients who were diagnosed with prostate cancer, and underwent prostatectomy during 2001 and 2011. We determined the risk of iatrogenic complication and length of stay (LOS) over time among open and minimally invasive surgery (MIS) patients. Hierarchical multivariable logistic regression was performed to assess the changes over time and elucidate independent predictors of iatrogenic complications. RESULTS We identified 556,932 and 219,434 prostate cancer patients undergoing open and minimally invasive prostatectomy. We found that iatrogenic complications for MIS were less frequent in later years (years 09-11 vs. year 01-02 odds ratio (OR), 0.21; 95% confidence intervals (CI), 0.09-0.40). MIS was associated with higher risk of iatrogenic complications in early period (years 01-02 OR, 3.81; 95% CI, 1.72-8.41), but lower risk in late period (years 09-11 OR 0.72 95% CI 0.61-0.86). Patients who experienced iatrogenic complications tended to have longer LOS (Median: Open vs. MIS, 4 days vs. 3 day) than those who didn't (Median: Open vs. MIS, 2 days vs. 1 day), regardless of procedure type. CONCLUSION We found that minimally invasive prostatectomy is associated with lower risk of iatrogenic complications when compared with open surgery (OS). However, as "learning curve" is overcome over time, MIS becomes safer than OS. Iatrogenic complications are not benign and seem to be associated with higher burden of inpatient care.
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Affiliation(s)
- Bilal Chughtai
- 1 Department of Urology, Weill Medical College of Cornell University , New York-Presbyterian Hospital, New York, New York
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Gagnon LO, Goldenberg SL, Lynch K, Hurtado A, Gleave ME. Comparison of open and robotic-assisted prostatectomy: The University of British Columbia experience. Can Urol Assoc J 2014; 8:92-7. [PMID: 24839475 DOI: 10.5489/cuaj.1707] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital. METHODS We retrospectively analyzed 200 consecutive OP by 1 experienced open surgeon (MG) and 200 consecutive RAP by an experienced open surgeon (SLG), after allowing for a short learning curve of 70 cases. RESULTS The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (Clavien-Dindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes. CONCLUSION While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.
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Affiliation(s)
- Louis-Olivier Gagnon
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - S Larry Goldenberg
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Kenny Lynch
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Antonio Hurtado
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Martin E Gleave
- The Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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