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Soputro NA, Chavali JS, Ramos-Carpinteyro R, Mikesell C, Pedraza AM, Kaouk JH. Perioperative Complications of Single-Port and Multiport Robotic Radical Prostatectomy: A Single Institutional Comparison Analysis. J Endourol 2024; 38:450-457. [PMID: 38420656 DOI: 10.1089/end.2023.0652] [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] [Indexed: 03/02/2024] Open
Abstract
Background: Following its introduction in 2018, the Single-Port (SP) robotic platform has been increasingly utilized for various approaches of robotic radical prostatectomy (RARP). Despite the demonstrable benefits in enhancing postoperative outcomes, there has been limited evidence on its perioperative morbidity, especially when compared to the gold-standard multiport (MP). This study sought to compare the perioperative morbidity between SP and MP-RARP. Methods: A retrospective review was performed on 911 patients who underwent RARP between January 2015 and May 2023. At our institution, SP-RARP has been performed since October 2018 with Extraperitoneal and Transvesical (TV) techniques. To reduce the risk of selection bias, only MP-RARP cases performed before October 2018 were included. Baseline clinicodemographic and perioperative parameters were collected. Perioperative complications were classified in accordance to the Clavien-Dindo system with postoperative complications and readmission reported within 90 days of surgery. Statistical analysis was performed with R Packages for Statistical Computing with descriptive statistics as presented. Results: Of the 484 SP and 322 MP-RARP cases included in our analysis, one intraoperative complication was reported, which pertained to a small enterotomy during TV SP-RARP. Postoperative complications were identified in 14.5% and 14.6% of SP and MP-RARP cases (p = 0.989), respectively. Major complication represents 4.1% of the SP and 3.4% of MP cohorts. The 90-day rates of hospital readmission following SP and MP-RARP were 5.6% and 4.9%, respectively (p = 0.717). Limitations of this study included the retrospective single surgeon, single institution nature of our series that also included the early learning curve experience associated with the novel SP platform. Conclusion: This comparative study provided evidence highlighting the low rates of perioperative complication and readmission following SP-RARP that were comparable to the Transperitoneal MP approach. The low morbidity associated with SP-RARP supports its wider application as an addition to the contemporary minimally invasive surgical armamentariums for prostate cancer.
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Affiliation(s)
- Nicolas A Soputro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaya S Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roxana Ramos-Carpinteyro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carter Mikesell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adriana M Pedraza
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Homer A, Golijanin B, Schmitt P, Bhatt V, Pareek G, Hyams ES. Epidemiology of and Risk Factors in Postoperative Complications from Robotically Assisted Laparoscopic Radical Prostatectomy in Contemporary National Surgical Quality Improvement Program Data. J Endourol 2024; 38:270-275. [PMID: 38251639 DOI: 10.1089/end.2023.0388] [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] [Indexed: 01/23/2024] Open
Abstract
Introduction: For localized clinically significant prostate cancer (csPCa), robotically assisted laparoscopic radical prostatectomy (RALP) is the gold standard surgical treatment. Despite low overall complication rate, continued quality assurance (QA) efforts to minimize complications of RALP are important, particularly given movement toward same-day discharge. In 2019, National Surgical Quality Improvement Program (NSQIP) began collecting RALP-specific data. In this study, we assessed pre- and perioperative factors associated with postoperative complications for RALP to further QA efforts. Materials and Methods: Surgical records of csPCa patients who underwent RALP were retrieved from the 2019 to 2021 NSQIP database, including new RALP-specific data. Multivariate logistic regression evaluated the association between risk factors and outcomes specific to RALP and pelvic lymph node dissection (PLND). Input variables included American Society of Anesthesiologists (ASA) class, age, operative time, and body mass index (BMI). Variables from the extended dataset with PLND information included number of nodes evaluated, perioperative antibiotics, postoperative venous thromboembolism (VTE) prophylaxis, history of prior pelvic surgery, and history of prior radiotherapy (RT). Outcomes of interest were any surgical complication, infection, pulmonary embolism, deep venous thrombosis, acute kidney injury, pneumonia, lymphocele, and urinary/anastomotic leak (UAL). Results: A total of 11,811 patients were included with 6.1% experiencing any complication. Prior RT, prior pelvic surgery, older age, higher BMI, lack of perioperative antibiotic therapy, longer operative time, PLND, and number of lymph nodes dissected were associated with higher risk of postoperative complications. Regarding procedure-specific complications, there were increased odds of UAL with prior RT, prior pelvic surgery, longer operative time, and higher BMI. Odds of developing lymphocele increased with prior pelvic surgery, performance of PLND, and increased number of nodes evaluated. Conclusion: In contemporary NSQIP data, RALP is associated with low complication rates; however, these rates have increased compared with historical studies. Attention to and counseling regarding risk factors for peri- and postoperative complications are important to set expectations and minimize risk of unplanned return to a health care setting after discharge.
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Affiliation(s)
- Alexander Homer
- Minimally Invasive Urology Institute at the Miriam Hospital, Providence, Rhode Island, USA
- Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Borivoj Golijanin
- Minimally Invasive Urology Institute at the Miriam Hospital, Providence, Rhode Island, USA
- Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phillip Schmitt
- Minimally Invasive Urology Institute at the Miriam Hospital, Providence, Rhode Island, USA
- Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vikas Bhatt
- Minimally Invasive Urology Institute at the Miriam Hospital, Providence, Rhode Island, USA
- Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute at the Miriam Hospital, Providence, Rhode Island, USA
- Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Elias S Hyams
- Minimally Invasive Urology Institute at the Miriam Hospital, Providence, Rhode Island, USA
- Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Zhu W, Wu L, Xie W, Zhang G, Gu Y, Hou Y, He Y. Wound infection in robotic-assisted radical prostatectomy compared with retropubic radical prostate surgery: A meta-analysis. Int Wound J 2023; 20:3550-3557. [PMID: 37675805 PMCID: PMC10588328 DOI: 10.1111/iwj.14228] [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: 04/16/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 09/08/2023] Open
Abstract
A meta-analysis investigation was executed to measure the wound infection (WI) in robotic-assisted radical prostatectomy (RRP) compared with retropubic radical prostate surgery (RRPS). A comprehensive literature investigation till February 2023 was applied, and 1197 interrelated investigations were reviewed. The 19 chosen investigations enclosed 107 153 individuals with prostate cancer (PC) at the starting point. 72 008 of them were utilising RRP, and 35 145 were utilising RRPS. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilised to compute the value of the WI in RRP compared with RRPS by the dichotomous approaches and a fixed or random model. RRP had significantly lower surgical site wound infection (SSWI) (OR, 0.33; 95% CI, 0.21-0.52, P < .001) and infected lymphoceles (ILs) (OR, 0.45; 95% CI, 0.22-0.92, P = .03) compared with RRPS in individuals with PC. RRP had significantly lower SSWI and ILs compared with RRPS in individuals with PC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
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Affiliation(s)
- Wei Zhu
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Lingfeng Wu
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Wenhua Xie
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Gaoyue Zhang
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Yanqin Gu
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Yansong Hou
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Yi He
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
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Li J, Chen T, Gao J, Peng F, Gu T, Jin B. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients undergoing prostatectomy: a multicentre, prospective, observational cohort study protocol. BMJ Open 2023; 13:e074763. [PMID: 37553190 PMCID: PMC10414067 DOI: 10.1136/bmjopen-2023-074763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Symptom monitoring and alerting based on patient-reported outcomes have proven valuable in a postoperative setting. However, the parameters of the implemented patient-centred symptom management system for patients with prostate cancer (PC) remain unclear. This study aims to develop a perioperative symptom scale (PSS) to monitor symptoms, determine the appropriate timing for symptom assessment and establish intervention criteria for physicians. METHODS AND ANALYSIS We will prospectively recruit 387 patients undergoing PC surgery in 3 hospitals. The Chinese version of the MD Anderson Symptom Inventory (MDASI) will be used for longitudinal symptom data collection, presurgery and 1, 2, 3, 5, 7, 14, 21, 28, 42 and 90 days post surgery. A PSS will be generated when symptoms change significantly over time. A linear mixed model will be used to determine appropriate follow-up time points. The functional status determined by MDASI interference can then be used to establish alarm thresholds. ETHICS AND DISSEMINATION This study was approved by the Lishui Municipal Central Hospital Ethics Committee on 13 April 2022 (No. LSMCHEC-2022-54) and the Ethics Committee of Huzhou Central Hospital on 5 July 2023 (No. HZCHEC-202306017-01), the Ethics Committee of the First Affiliated Hospital of Huzhou Normal College on 20 June 2023 (No. HZYYEC-2023KYLL055). The latest protocol used in this study was V.2.0, dated on 25 February 2023. Before publication in a peer-reviewed journal, our findings will be presented and discussed at relevant medical conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059110.
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Affiliation(s)
- Jie Li
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Ting Chen
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Jianguo Gao
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang, China
| | - Fusheng Peng
- Department of Urology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Tengfei Gu
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Baiye Jin
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Engineering Research Center for Urinary Bladder Carcinoma Innovation Diagnosis and Treatment, Hangzhou, Zhejiang, China
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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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Radical prostatectomy readmissions: Causes, risk factors, national rates, & costs. Urol Oncol 2023; 41:106.e1-106.e8. [PMID: 36402714 DOI: 10.1016/j.urolonc.2022.10.022] [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: 06/28/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Readmissions have substantial clinical and financial impacts on the healthcare system. Radical prostatectomy (RP) is considered a standard treatment in the management of clinically localized prostate cancer. Yet, there is a paucity of research evaluating readmissions for RP in a national dataset. PATIENTS AND METHODS Patients with histologically confirmed prostate cancer managed with RP were identified within the 2016 to 2018 Nationwide Readmissions Database. Patient factors, facility factors, and surgical characteristics were evaluated for associations with readmission using univariable and multivariable analyses. RESULTS A total of 133,727 patients receiving RP were identified. Early (30-day) and late (31-90-day) readmission rates were 4.2% and 1.8% respectively. The most common cause of early readmission was postoperative digestive system complication (10%) and the most common cause of late readmission was septicemia (13%). On multivariable logistic regression, factors associated with both early and late readmission include nonroutine discharge at index (early: OR 1.877, 95% CI 1.667-2.113; late: OR 1.801, 95% CI 1.490-2.183), and circulatory system comorbidity (early: OR 1.29, 95% CI 1.082-1.538); late: OR 1.515, 95% CI 1.157-1.984). CONCLUSIONS Our findings regarding factors associated with readmission provide insight for RP counseling and may inform postoperative care pathways. Elucidation of readmission trends may allow the identification and proactive management of patients at higher risk for readmission.
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Małkiewicz B, Kiełb P, Karwacki J, Czerwińska R, Długosz P, Lemiński A, Nowak Ł, Krajewski W, Szydełko T. Utility of Lymphadenectomy in Prostate Cancer: Where Do We Stand? J Clin Med 2022; 11:jcm11092343. [PMID: 35566471 PMCID: PMC9103547 DOI: 10.3390/jcm11092343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this review is to summarize the current knowledge on lymph node dissection (LND) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Despite a growing body of evidence, the utility and therapeutic and prognostic value of such an approach, as well as the optimal extent of LND, remain unsolved issues. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, which limits the possibility of establishing clear recommendations. This indicates the need for further robust and adequately designed high-quality clinical trials.
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Affiliation(s)
- Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Jakub Karwacki
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Róża Czerwińska
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Paulina Długosz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
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Cheng X, Zhou L, Liu W, Li Y, Peng M, Wang Y. Construction and Verification of Risk Predicting Models to Evaluate the Possibility of Venous Thromboembolism After Robot-Assisted Radical Prostatectomy. Ann Surg Oncol 2022; 29:5297-5306. [PMID: 35316433 PMCID: PMC9246795 DOI: 10.1245/s10434-022-11574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Background Venous thromboembolism (VTE) is the second leading cause for death of radical prostatectomy. We aimed to establish new nomogram to predict the VTE risk after robot-assisted radical prostatectomy (RARP). Methods Patients receiving RARP in our center from November 2015 to June 2021, were enrolled in study. They were randomly divided into training and testing cohorts by 8:2. Univariate and multivariate logistic regression (model A) and stepwise logistic regression (model B) were used to fit two models. The net reclassification improvement (NRI), integrated discrimination improvement (IDI), and receiver operating characteristic (ROC) curve were used to compare predictive abilities of two new models with widely used Caprini risk assessment (CRA) model. Then, two nomograms were constructed and received internal validation. Results Totally, 351 patients were included. The area under ROC of model A and model B were 0.967 (95% confidence interval: 0.945–0.990) and 0.978 (95% confidence interval: 0.960–0.996), which also were assayed in the testing cohorts. Both the prediction and classification abilities of the two new models were superior to CRA model (NRI > 0, IDI > 0, p < 0.05). The C-index of Model A and Model B were 0.968 and 0.978, respectively. For clinical usefulness, the two new models offered a net benefit with threshold probability between 0.08 and 1 in decision curve analysis, suggesting the two new models predict VTE events more accurately. Conclusions Both two new models have good prediction accuracy and are superior to CRA model. Model A has an advantage of less variable. This easy-to-use model enables rapid clinical decision-making and early intervention in high-risk groups, which ultimately benefit patients. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-11574-5.
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Affiliation(s)
- Xu Cheng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lizhi Zhou
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Wentao Liu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yijian Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Mou Peng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Influence of steep Trendelenburg position on postoperative complications: a systematic review and meta-analysis. J Robot Surg 2021; 16:1233-1247. [PMID: 34972981 PMCID: PMC9606098 DOI: 10.1007/s11701-021-01361-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022]
Abstract
Intraoperative physiologic changes related to the steep Trendelenburg position have been investigated with the widespread adoption of robot-assisted pelvic surgery (RAPS). However, the impact of the steep Trendelenburg position on postoperative complications remains unclear. We conducted a meta-analysis to compare RAPS to laparoscopic/open pelvic surgery with regards to the rates of venous thromboembolism (VTE), cardiac, and cerebrovascular complications. Meta-regression was performed to evaluate the influence of confounding risk factors. Ten randomized controlled trials (RCTs) and 47 non-randomized controlled studies (NRSs), with a total of 380,125 patients, were included. Although RAPS was associated with a decreased risk of VTE and cardiac complications compared to laparoscopic/open pelvic surgery in NRSs [risk ratio (RR), 0.59; 95% CI 0.51–0.72, p < 0.001 and RR 0.93; 95% CI 0.58–1.50, p = 0.78, respectively], these differences were not confirmed in RCTs (RR 0.92; 95% CI 0.52–1.62, p = 0.77 and RR 0.93; 95% CI 0.58–1.50, p = 0.78, respectively). In subgroup analyses of laparoscopic surgery, there was no significant difference in the risk of VTE and cardiac complications in both RCTs and NRSs. In the meta-regression, none of the risk factors were found to be associated with heterogeneity. Furthermore, no significant difference was observed in cerebrovascular complications between RAPS and laparoscopic/open pelvic surgery. Our meta-analysis suggests that the steep Trendelenburg position does not seem to affect postoperative complications and, therefore, can be considered safe with regard to the risk of VTE, cardiac, and cerebrovascular complications. However, proper individualized preventive measures should still be implemented during all surgeries including RAPS to warrant patient safety.
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Lakomkin N, Stannard B, Fogelson JL, Mikula AL, Lenke LG, Zuckerman SL. Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations. Spine J 2021; 21:1784-1792. [PMID: 34332146 DOI: 10.1016/j.spinee.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity (ASD) surgeries are complex, involving long operative times and surgical morbidity. It is currently unclear how the invasiveness of ASD surgery compares to other major operations. PURPOSE To: (1) develop a quantitative score of surgical morbidity and invasiveness, and (2) compare this score between ASD surgery and other major operations. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE A prospective surgical registry was used to identify all patients undergoing ASD surgery involving ≥ 7 segments. Seventeen additional procedures were included: coronary artery bypass grafting (CABG), pancreatectomy, and esophagectomy, among others. OUTCOME MEASURES Perioperative factors (operative time, transfusions, ventilation) and complications were collected and combined with a previously validated Postoperative Morbidity Survey to create a Surgical Invasiveness and Morbidity Score (SIMS). METHODS Computed scores were compared across surgeries using Welch's t-test. Multiple linear regression modeling was used to compare the SIMS of major surgeries relative to ASD while controlling for patient demographics and comorbidities. RESULTS A total of 1,245,282 surgical patients were included, 4,656 of which underwent ASD surgery. After multiple regression modeling controlling for patient demographics and comorbidities, ASD surgery ranked fourth in SIMS. ASD surgery had a significantly greater SIMS than 13 other major procedures including 6th esophagectomy (adjusted mean difference=-0.05, 95%CI -0.01-0.09, p<.001), 8th pancreatectomy (-0.40, 0.37-0.44, p<.001), 11th craniotomy for tumor (-1.01, 0.98-1.04, p<.001), and 12th sacral chordoma resection (-1.31, 1.26-1.37, p<.001). CONCLUSIONS ASD surgery was associated with significantly greater SIMS than many other major operations, even when controlling for important perioperative factors. These data have implications for patient counseling, resource allocation, and informed consent.
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Affiliation(s)
- Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
| | - Blaine Stannard
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Medical Center, New York, NY, USA; Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA.
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12
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Porcaro AB, Rizzetto R, Amigoni N, Tafuri A, Shakir A, Tiso L, Cerrato C, Antoniolli SZ, Lacola V, Gozzo A, Odorizzi K, Orlando R, Di Filippo G, Brunelli M, Migliorini F, De Marco V, Artibani W, Cerruto MA, Antonelli A. Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy. J Robot Surg 2021; 16:463-471. [PMID: 34131882 PMCID: PMC8960588 DOI: 10.1007/s11701-021-01262-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
To evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001-1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien-Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien-Dindo complications were seen.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy.
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy. .,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.
| | - Aliasger Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Leone Tiso
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Clara Cerrato
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Stefano Zecchini Antoniolli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Vincenzo Lacola
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Alessandra Gozzo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Katia Odorizzi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Rossella Orlando
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Giacomo Di Filippo
- Department of General and Hepatobiliary Surgery, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale Stefani, 137126, Verona, Italy
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13
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Pessoa RR, Maroni P, Kukreja J, Kim SP. Comparative effectiveness of robotic and open radical prostatectomy. Transl Androl Urol 2021; 10:2158-2170. [PMID: 34159098 PMCID: PMC8185666 DOI: 10.21037/tau.2019.12.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radical prostatectomy (RP) has undergone a remarkable transformation from open to minimally-invasive surgery over the last two decades. However, it is important to recognize there is still conflicting evidence regarding key outcomes. We aimed to summarize current literature on comparative effectiveness of robotic and open RP for key outcomes including oncologic results, health-related quality of life (HRQOL) measures, safety and postoperative complications, and healthcare costs. The bulk of the paper will discuss and interpret limitations of current data. Finally, we will also highlight future directions of both surgical approaches and its potential impact on health care delivery.
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Affiliation(s)
| | - Paul Maroni
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Janet Kukreja
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Cancer Outcomes and Public Policy Effectiveness Research (COPPER), Yale University, New Haven, Connecticut
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14
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Inoue S, Miyoshi H, Hieda K, Hayashi T, Tsutsumi YM, Teishima J. Postoperative around-the-clock administration of intravenous acetaminophen for pain control following robot-assisted radical prostatectomy. Sci Rep 2021; 11:5174. [PMID: 33664398 PMCID: PMC7933238 DOI: 10.1038/s41598-021-84866-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/19/2021] [Indexed: 11/09/2022] Open
Abstract
The objective of this study was to examine the impact of around-the-clock (ATC) administration of intravenous (IV) acetaminophen following robot-assisted radical prostatectomy (RARP). Intravenous infusion of acetaminophen was started on the day of the operation at 1000 mg/dose every 6 h, and the infusion was continued on a fixed schedule until postoperative day 2 a.m. In a retrospective observational study, we compared 127 patients who were administered IV acetaminophen on a fixed schedule (ATC group) with 485 patients who were administered analgesic drugs only as needed (PRN group). We investigated postoperative pain intensity and additional analgesic consumption on postoperative day 0, 1, 2, 3, and 5 between the two groups. Postoperative pain scores were significantly lower in the ATC group than in the PRN group at 1 and 2 days, and this period matched the duration of ATC administration of IV acetaminophen. Postoperative frequency of rescue analgesia was significantly lower in the ATC group than in the PRN group at postoperative 0, 1, and 2 days. ATC administration of IV acetaminophen has the potential to be a very versatile and valuable additional dose to achieve appropriate postoperative analgesia in patients with RARP.
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Affiliation(s)
- Shogo Inoue
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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15
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Omil-Lima DO, Gupta K, Calaway AC, Zell MA. Historical Considerations and Surgical Quality Improvement in Robotic Prostatectomy. Urol Clin North Am 2020; 48:35-44. [PMID: 33218592 DOI: 10.1016/j.ucl.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.
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Affiliation(s)
- Danly O Omil-Lima
- Urology Institute, University Hospitals-Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Karishma Gupta
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam C Calaway
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael A Zell
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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16
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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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17
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Tang AB, Childers CP, Dworsky JQ, Maggard-Gibbons M. Surgeon work captured by the National Surgical Quality Improvement Program across specialties. Surgery 2020; 167:550-555. [DOI: 10.1016/j.surg.2019.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/03/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
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18
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Strother MC, Michel KF, Xia L, McWilliams K, Guzzo TJ, Lee DJ, Lee DI. Prolonged Length of Stay After Robotic Prostatectomy: Causes and Risk Factors. Ann Surg Oncol 2020; 27:1560-1567. [PMID: 32103416 DOI: 10.1245/s10434-020-08266-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) can generally be performed with 1-2 nights of postoperative monitoring before discharge from the hospital. Little is known about what causes individual patients to remain in hospital beyond the second postoperative day. METHODS Data for RARPs performed between 2013 and 2015 were extracted from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The fraction of cases with prolonged length of stay (PLOS) that can be reasonably attributed to complications was examined. Logistic regression was performed to identify risk factors for PLOS in the overall population and separately in the population of patients with PLOS without any perioperative complications. RESULTS Of 11,440 patients, 10,342 (90.4%) were discharged on postoperative days 0-2; 80.6% (887/1101) of patients with PLOS did not experience any perioperative complications. The most common complication was bleeding requiring transfusion, but this was present in only 5.6% (62/1101) of patients with PLOS. Logistic regression identified predictors of PLOS as age, race, wound class, American Society of Anesthesiologists class, smoking, diabetes, dyspnea, dependent functional health status, congestive heart failure, operative time, and pelvic lymph node dissection. Results of this regression were insensitive to the exclusion of patients who experienced no perioperative complications. CONCLUSIONS This study utilizes logistic regression on NSQIP data to identify risk factors for PLOS after RARP and, in particular, to evaluate the role of postoperative complications in PLOS. The analysis shows that postoperative complications account for a small minority of cases of PLOS after RARP.
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Affiliation(s)
- Marshall C Strother
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Katharine F Michel
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Leilei Xia
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | | | - Thomas J Guzzo
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Daniel J Lee
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - David I Lee
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA, USA
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19
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Tafuri A, Sebben M, Pirozzi M, Processali T, Shakir A, Rizzetto R, Amigoni N, Tiso L, De Michele M, Panunzio A, Cerrato C, Migliorini F, Novella G, De Marco V, Siracusano S, Artibani W, Porcaro AB. Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report. Urol Int 2020; 104:465-475. [PMID: 31991418 DOI: 10.1159/000505409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the predictors of the risk of long-term hospital readmission after radical prostatectomy (RP) in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. MATERIALS AND METHODS The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the 2 surgical approaches. Patients were followed for complications and hospital readmission for a period of 6 months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. RESULTS From December 2013 to 2017, 885 patients underwent RP. RARP was performed in 733 cases and ORP in 152 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 479 patients. Hospital readmission was detected in 46 cases (5.2%). Using a multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (hazard ratio [HR] 2.065; 95% CI 1.116-3.283; p = 0.021), ORP (HR 3.506; 95% CI 1.919-6.405; p < 0.0001), and ePLND (HR 5.172; 95% CI 1.778-15.053; p < 0.0001). CONCLUSIONS In a large single tertiary referral center, independent predictors of the risk of long-term hospital readmission after RP included ORP, ePLND, and seminal vesicle invasion. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of long-term hospital readmission and its related risk factors.
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Affiliation(s)
- Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.,USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Marco Sebben
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Marco Pirozzi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Tania Processali
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Aliasger Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Leone Tiso
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Mario De Michele
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni Novella
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy,
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20
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The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy. World J Urol 2020; 38:2799-2809. [PMID: 31980875 DOI: 10.1007/s00345-020-03094-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with the risk of hospital readmission after robot assisted radical prostatectomy (RARP) with or without extended pelvic lymph node dissection (ePLND) for prostate cancer (PCA) over a long term. MATERIALS AND METHODS The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the procedures. Patients were followed for complications and hospital readmission for a period of six months. The logistic regression model and Cox's proportional hazards assessed the association of factors with the risk of readmission. RESULTS From January 2013 to December 2018, 890 patients underwent RARP; ePLND was performed in 495 of these patients. Hospital readmission was detected in 25 cases (2.8%); moreover, it was more frequent when RARP was performed with ePLND (4.4% of cases) than without (0.8% of patients). On the final multivariate model, ePLND was the only independent factor that was positively associated with the risk of hospital readmission (hazard ratio, HR = 5935; 95%CI 1777-19,831; p = 0.004). CONCLUSIONS Over the long term after RARP for PCA, the risk of hospital readmission is associated with ePLND. In patients who underwent RARP and ePLND, 4.4% of them had a readmission, compared to RARP alone, in which only 0.8% of cases had a readmission. When ePLND is planned for staging pelvic lymph nodes, patients should be informed of the increased risk of hospital readmission.
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21
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Sebben M, Tafuri A, Pirozzi M, Processali T, Rizzetto R, Amigoni N, Shakir A, De Michele M, Panunzio A, Cerrato C, Tiso L, Novella G, Brunelli M, Migliorini F, De Marco V, Siracusano S, Artibani W, Porcaro AB. Open approach, extended pelvic lymph node dissection, and seminal vesicle invasion are independent predictors of hospital readmission after prostate cancer surgery: a large retrospective study. MINERVA UROL NEFROL 2019; 72:72-81. [PMID: 31833722 DOI: 10.23736/s0393-2249.19.03586-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study is to evaluate factors (clinical, pathological and perioperative) associated with the risk of hospital readmission after radical prostatectomy (RP) over the long term in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. METHODS From January 2013 to December 2018 patients older than 18 years, who provided signed consent and underwent open or robot assisted radical prostatectomy were enrolled and retrospectively evaluated. Patients who underwent any previous prostate cancer (PCA) treatments were excluded. Specifically, skilled and experienced surgeons performed the two surgical approaches. Patients were followed for complications and hospital readmission (RAD) for a period of six months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. RESULTS A total of 1062 patients underwent RP. RARP was performed in 891 cases and ORP in 171 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 651 patients. Hospital readmission occurred in 53 cases (5%). Based on the final multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (HR=2.093; 95% CI: 1.177-3.722), ORP (HR=4.393; 95% CI: 2.516-7.672) and ePLND (HR=4.418; 95% CI: 1.544-12.639). CONCLUSIONS ORP, ePLND and seminal vesicle invasion are independent predictors of the risk of hospital readmission over the long term at a large single tertiary referral center. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of hospital readmission and related risk factors. Assessing seminal vesicle invasion by preoperative clinical staging identifies locally advanced disease, which is associated with an increased risk of hospital readmission.
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Affiliation(s)
- Marco Sebben
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy.,Catherine and Joseph Aresty Department of Urology, Institute of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Marco Pirozzi
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Tania Processali
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Aliasger Shakir
- Catherine and Joseph Aresty Department of Urology, Institute of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Mario De Michele
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Andrea Panunzio
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Clara Cerrato
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Leone Tiso
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Giovanni Novella
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, Verona University Hospital, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Salvatore Siracusano
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Antonio B Porcaro
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy -
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Stull JD, Mangan JJ, Vaccaro AR, Schroeder GD. Robotic Guidance in Minimally Invasive Spine Surgery: a Review of Recent Literature and Commentary on a Developing Technology. Curr Rev Musculoskelet Med 2019; 12:245-251. [PMID: 31037519 DOI: 10.1007/s12178-019-09558-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Minimally invasive spine surgery (MIS) and robotic technology are growing in popularity and are increasing utilized in combination. The purpose of this review is to identify the current successes, potential drawbacks, and future directions of robotic guidance for MIS compared to traditional techniques. RECENT FINDINGS Recent literature highlights successful incorporation of robotic guidance in MIS as a consistently accurate method for pedicle screw placement. With a short learning curve and low complication rates, robot guidance may also reduce the use of fluoroscopy, operative time, and length of hospital stay. Recent literature suggests that incorporating robotic guidance in MIS improves the accuracy of pedicle screw insertion and may have added benefits both intra- and postoperatively for the patient and provider. Future research should focus on direct comparison between MIS with and without robotic guidance.
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Affiliation(s)
- Justin D Stull
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Fifth Floor, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - John J Mangan
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Fifth Floor, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Fifth Floor, 925 Chestnut Street, Philadelphia, PA, 19107, USA.,The Rothman Institute, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Fifth Floor, 925 Chestnut Street, Philadelphia, PA, 19107, USA.,The Rothman Institute, Philadelphia, PA, USA
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Effect of an Evidence-based Inpatient Tobacco Dependence Treatment Service on 1-Year Postdischarge Health Care Costs. Med Care 2019; 56:883-889. [PMID: 30130271 PMCID: PMC6136961 DOI: 10.1097/mlr.0000000000000979] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. We previously demonstrated that patients exposed to the MUSC TDTS were approximately half as likely to be smoking one month after discharge and 23% less likely to have a 30-day hospital readmission. This paper examines whether exposure to the TDTS influenced downstream health care charges 12 months after patients were discharged from the hospital. Methods: Data from MUSC’s electronic health records, the TDTS, and statewide health care utilization datasets (eg, hospitalization, emergency department, and ambulatory surgery visits) were linked to assess how exposure to the MUSC TDTS impacted health care charges. Total health care charges were compared for patients with and without TDTS exposure. To reduce potential TDTS exposure selection bias, propensity score weighting was used to balance baseline characteristics between groups. The cost of delivering the MUSC TDTS intervention was calculated, along with cost per smoker. Results: The overall adjusted mean health care charges for smokers exposed to the TDTS were $7299 lower than for those who did not receive TDTS services (P=0.047). The TDTS cost per smoker was modest by comparison at $34.21 per smoker eligible for the service. Discussion: Results suggest that implementation of a TDTS consistent with JC standards for smoking cessation can be affordably implemented and yield substantial health care savings that would benefit patients, hospitals, and insurers.
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Klaassen Z, Wallis CJD, Lavallée LT, Violette PD. Perioperative venous thromboembolism prophylaxis in prostate cancer surgery. World J Urol 2019; 38:593-600. [DOI: 10.1007/s00345-019-02705-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/25/2019] [Indexed: 01/31/2023] Open
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25
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Dandapani HG, Tieu K. The contemporary role of robotics in surgery: A predictive mathematical model on the short-term effectiveness of robotic and laparoscopic surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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26
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Shahait M, Yezdani M, Katz B, Lee A, Yu SJ, Lee DI. Robot-Assisted Transversus Abdominis Plane Block: Description of the Technique and Comparative Analysis. J Endourol 2019; 33:207-210. [PMID: 30652509 DOI: 10.1089/end.2018.0828] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several randomized clinical trials have shown the efficacy of percutaneous transversus abdominis plane (TAP) block in decreasing pain after open and minimally invasive surgeries. We postulated that TAP block could be performed by a robot-assisted transperitoneal approach and provide postoperative pain control equivalent to local anesthetic port infiltration. OBJECTIVE To compare different indicators of postoperative pain between robot-assisted TAP and local anesthetic port infiltration in patients who had undergone robot-assisted radical prostatectomy (RARP). METHODOLOGY A retrospective comparison of 214 consecutive patients undergoing RARP over a 1-year period was conducted. Patient demographics, comorbidities, operative details, and outcomes, including time to ambulation, pain score, narcotic usage, and length of stay, were compared. RESULTS In total, 206 patients were included: 101 received local anesthetic port infiltration and 105 robot-assisted TAP block. There were no differences in estimated blood loss, operative time, time to ambulation, and length of stay between the two groups. The robot-assisted TAP block cohort experienced lesser pain than the local anesthetic port infiltration cohort in the intervals of 6 to 12 hours (2.05 vs 3.21, p = 0.0016) and 12 to 18 hours (2.19 vs 2.97, p = 0.0495) postoperation. CONCLUSION Robot-assisted TAP block is a safe alternative to local anesthetic port-site infiltration. Robot-assisted TAP is associated with lower postoperative pain scores and less narcotic use than local anesthetic port-site infiltration.
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Affiliation(s)
- Mohammed Shahait
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mona Yezdani
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Katz
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexandra Lee
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue-Jean Yu
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I Lee
- Division of Urology, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania
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Zeng J, Christiansen A, Pooli A, Qiu F, LaGrange CA. Safety and Clinical Outcomes of Robot-Assisted Radical Prostatectomy in Kidney Transplant Patients: A Systematic Review. J Endourol 2018; 32:935-943. [PMID: 30039723 DOI: 10.1089/end.2018.0394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature. MATERIALS AND METHODS A literature search was performed using PubMed, Embase, and Web of Science through "robot" AND "prostatectomy" AND "transplant." Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review. RESULTS We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%. CONCLUSIONS RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.
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Affiliation(s)
- Jiping Zeng
- 1 College of Medicine, University of Nebraska Medical Center , Omaha, Nebraska
| | - Andrew Christiansen
- 2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska
| | - Aydin Pooli
- 3 Department of Urology, David Geffen School of Medicine at University of California , Los Angeles, California
| | - Fang Qiu
- 4 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
| | - Chad A LaGrange
- 2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska
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28
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Rude TL, Donin NM, Cohn MR, Meeks W, Gulig S, Patel SN, Wysock JS, Makarov DV, Bjurlin MA. Analysis of National Trends in Hospital Acquired Conditions Following Major Urologic Surgery Before and After Implementation of the Hospital Acquired Condition Reduction Program. Urology 2018; 119:79-84. [PMID: 29885778 DOI: 10.1016/j.urology.2018.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To define the rates of common hospital acquired conditions (HACs) in patients undergoing major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program, and to evaluate whether implementation of the HAC reimbursement penalties in 2008 was associated with a change in the rate of HACs. METHODS Using American College of Surgeons National Surgical Quality Improvement Program data, we determined rates of HACs in patients undergoing major inpatient urologic surgery from 2005 to 2012. Rates were stratified by procedure type and approach (open vs laparoscopic and/or robotic). Multivariable logistic regression was used to determine the association between year of surgery and HACs. RESULTS We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.9%) had at least one hospital acquired condition. Urinary tract infection (2.6%) was the most common, followed by surgical site infection (2.5%) and venous thrombotic events (0.7%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, congestive heart failure, chronic obstructive pulmonary disease, weight loss, and American Society of Anesthesiology class were among the variables associated with higher likelihood of HAC. We observed a nonsignificant secular trend of decreasing rates of HAC from 7.4% to 5.8% HACs during the study period, which encompassed the implementation of the Hospital Acquired Condition Reduction program. CONCLUSION HACs occurred at a rate of 5.9% after major urologic surgery, and are significantly affected by procedure type and patient health status. The rate of HAC appeared unaffected by National Reduction program in this cohort. Better understanding of the factors associated with HACs is critical in developing effective reduction programs.
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Affiliation(s)
- Tope L Rude
- Department of Urology, New York University School of Medicine, New York, NY
| | - Nicholas M Donin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - William Meeks
- Data Management and Statistical Services, American Urological Association, Linthicum, MD
| | - Scott Gulig
- Data Management and Statistical Services, American Urological Association, Linthicum, MD
| | | | - James S Wysock
- Department of Urology, New York University School of Medicine, New York, NY
| | - Danil V Makarov
- Department of Urology, New York University School of Medicine, New York, NY
| | - Marc A Bjurlin
- Department of Urology, New York University School of Medicine, New York, NY.
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Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 2018; 229:134-144. [PMID: 29936980 DOI: 10.1016/j.jss.2018.03.022] [Citation(s) in RCA: 405] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to systematically synthesize the large volume of literature reporting on the association between operative duration and complications across various surgical specialties and procedure types. METHODS An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from January 2005 to January 2015 was conducted. Sixty-six observational studies met the inclusion criteria. RESULTS Pooled analyses showed that the likelihood of complications increased significantly with prolonged operative duration, approximately doubling with operative time thresholds exceeding 2 or more hours. Meta-analyses also demonstrated a 14% increase in the likelihood of complications for every 30 min of additional operating time. CONCLUSIONS Prolonged operative time is associated with an increase in the risk of complications. Given the adverse consequences of complications, decreased operative times should be a universal goal for surgeons, hospitals, and policy-makers. Future study is recommended on the evaluation of interventions targeted to reducing operating time.
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The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy. Urol Oncol 2018; 36:157.e7-157.e13. [DOI: 10.1016/j.urolonc.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/17/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022]
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31
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Cartmell KB, Dooley M, Mueller M, Nahhas GJ, Dismuke CE, Warren GW, Talbot V, Cummings KM. Effect of an Evidence-based Inpatient Tobacco Dependence Treatment Service on 30-, 90-, and 180-Day Hospital Readmission Rates. Med Care 2018; 56:358-363. [PMID: 29401186 PMCID: PMC5851827 DOI: 10.1097/mlr.0000000000000884] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Smoking is a risk factor for hospitalization and interferes with patient care due to its effects on pulmonary function, wound healing, and interference with treatments and medications. Although benefits of stopping smoking are well-established, few hospitals provide tobacco dependence treatment services (TDTS) due to cost, lack of mandatory tobacco cessation standards and lack of evidence demonstrating clinical and financial benefits to hospitals and insurers for providing services. METHODS This study explored the effect of an inpatient TDTS on 30-, 90-, and 180-day hospital readmissions. To carry out this work, 3 secondary datasets were linked, which included clinical electronic health record data, tobacco cessation program data, and statewide health care utilization data. Odds ratios (ORs) were calculated using inverse propensity score-weighted logistic regression models, with program exposure as the primary independent variable and 30 (90 and 180)-day readmission rates as the dependent variable, and adjustment for putative covariates. RESULTS Odds of readmission were compared for patients who did and did not receive TDTS. At 30 days postdischarge, smokers exposed to the TDTS had a lower odds of readmission (OR=0.77, P=0.031). At 90 and 180 days, odds of readmission remained lower in the TDTS group (ORs=0.87 and 0.86, respectively), but were not statistically significant. DISCUSSION Findings from the current study, which are supported by prior studies, provide evidence that delivery of TDTS is a strategy that may help to reduce hospital readmissions.
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Affiliation(s)
- Kathleen B. Cartmell
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Mary Dooley
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Georges J. Nahhas
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Clara E. Dismuke
- Center for Health Disparities, Medical University of South Carolina, Charleston, SC, USA
| | - Graham W. Warren
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | | | - K. Michael Cummings
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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32
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Tang K, Jiang K, Chen H, Chen Z, Xu H, Ye Z. Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and an meta-analysis update. Oncotarget 2018; 8:32237-32257. [PMID: 27852051 PMCID: PMC5458281 DOI: 10.18632/oncotarget.13332] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022] Open
Abstract
CONTEXT The safety and feasibility of robotic-assisted radical prostatectomy (RARP) compared with retropubic radical prostatectomy(RRP) is debated. Recently, a number of large-scale and high-quality studies have been conducted. OBJECTIVE To obtain a more valid assessment, we update the meta-analysis of RARP compared with RRP to assessed its safety and feasibility in treatment of prostate cancer. METHODS A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared RARP with RRP. Outcomes of interest included perioperative, pathologic variables and complications. RESULTS 78 studies assessing RARP vs. RRP were included for meta-analysis. Although patients underwent RRP have shorter operative time than RARP (WMD: 39.85 minutes; P < 0.001), patients underwent RARP have less intraoperative blood loss (WMD = -507.67ml; P < 0.001), lower blood transfusion rates (OR = 0.13; P < 0.001), shorter time to remove catheter (WMD = -3.04day; P < 0.001), shorter hospital stay (WMD = -1.62day; P < 0.001), lower PSM rates (OR:0.88; P = 0.04), fewer positive lymph nodes (OR:0.45;P < 0.001), fewer overall complications (OR:0.43; P < 0.001), higher 3- and 12-mo potent recovery rate (OR:3.19;P = 0.02; OR:2.37; P = 0.005, respectively), and lower readmission rate (OR:0.70, P = 0.03). The biochemical recurrence free survival of RARP is better than RRP (OR:1.33, P = 0.04). All the other calculated results are similar between the two groups. CONCLUSIONS Our results indicate that RARP appears to be safe and effective to its counterpart RRP in selected patients.
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Affiliation(s)
- Kun Tang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kehua Jiang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Hongbo Chen
- Department of Urology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Zhiqiang Chen
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Stone BV, Cohn MR, Donin NM, Schulster M, Wysock JS, Makarov DV, Bjurlin MA. Evaluation of Unplanned Hospital Readmissions After Major Urologic Inpatient Surgery in the Era of Accountable Care. Urology 2017; 109:94-100. [DOI: 10.1016/j.urology.2017.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 07/12/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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Baack Kukreja J, Kamat AM. Strategies to minimize readmission rates following major urologic surgery. Ther Adv Urol 2017; 9:111-119. [PMID: 28588648 PMCID: PMC5444623 DOI: 10.1177/1756287217701699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/28/2017] [Indexed: 01/10/2023] Open
Abstract
Readmissions after major surgical procedures are prevalent across multiple disciplines. Specifically, in urology, with incorporation of early discharge and recovery pathways, readmissions are emerging as an important problem and effecting an epidemic proportion of urology patients. As expected, readmissions have garnered the attention of major healthcare payers in the United States who see readmissions as easy targets because of the association with astronomical costs. More importantly, readmissions have a significant negative impact on patient sense of wellbeing, and places economic and other hardships on the doors of our patients and their families. Here, we explore the reasons patients are readmitted, using radical cystectomy as a case study, and means to decrease the incidence of readmissions. Since time to readmission for most major urologic oncology surgeries is within the first 2 weeks after discharge, this time frame is critical for efforts to improve symptom identification and reduce the total number and severity of readmissions. Readmission reduction to zero is unlikely for any major surgery, but with effective coordinated strategies, we must strive to reduce the rates as much as possible, as a means to improve the care continuum for our patients.
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Affiliation(s)
- Janet Baack Kukreja
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit #1373, Houston, TX 77030-4000, USA
| | - Ashish M. Kamat
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit #1373, Houston, TX 77030-4000, USA
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Xia L, Taylor BL, Pulido JE, Mucksavage P, Lee DI, Guzzo TJ. Predischarge Predictors of Readmissions and Postdischarge Complications in Robot-Assisted Radical Prostatectomy. J Endourol 2017; 31:864-871. [DOI: 10.1089/end.2017.0293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin L. Taylor
- Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jose E. Pulido
- Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Phillip Mucksavage
- Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I. Lee
- Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas J. Guzzo
- Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
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Levy I, Finkelstein M, Bilal KH, Palese M. Modified frailty index associated with Clavien-Dindo IV complications in robot-assisted radical prostatectomies: A retrospective study. Urol Oncol 2017; 35:425-431. [PMID: 28190748 DOI: 10.1016/j.urolonc.2017.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/29/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the effect of frailty on patient outcomes including any complication, Clavien-Dindo IV (CDIV) (intensive care unit-level) complications, and 30-day mortality for robotic-assisted radical prostatectomies (RARP) patients in comparison to other predictive indices using the modified frailty index (mFI). MATERIAL AND METHODS Patients undergoing RARP from 2008 to 2014 for a prostate cancer-related diagnosis were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The mFI was developed using the Canadian Study of Health and Aging Frailty Index as a model. The mFI was compared with other associative indices such as the American Society of Anesthesiology (ASA) classification and the Charlson comorbidity index (CCI). Rates of CDIV complications and 30-day mortality were analyzed based on mFI score using SAS version 9.22. RESULTS A total of 23,104 patients undergoing RARP were queried. RARP patients with the highest frailty score (≥3) had an adjusted odds for CDIV complications of Odds ratio of 12.107 (CI: 2.800-52.351, P< 0.005) in comparison with nonfrail RARP patients. These odds were higher than the ASA and Charlson comorbidity index. Additionally, a variable combining mFI and ASA had fair sensitivity and specificity for predicting 30-day mortality in RARP patients (C-statistic = 0.7097, P<0.0001). CONCLUSION Increasing mFI scores are associated with worsening outcomes for patients undergoing RARP. A combined mFI and ASA variable can be used to predict 30-day mortality for RARP patients better than mFI or ASA alone.
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Affiliation(s)
- Isaiah Levy
- Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | | | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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Moschini M, Gandaglia G, Fossati N, Dell'Oglio P, Cucchiara V, Luzzago S, Zaffuto E, Suardi N, Damiano R, Shariat SF, Montorsi F, Briganti A. Incidence and Predictors of 30-Day Readmission After Robot-Assisted Radical Prostatectomy. Clin Genitourin Cancer 2017; 15:67-71. [DOI: 10.1016/j.clgc.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
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Monn MF, Jaqua KR, Calaway AC, Mellon MJ, Koch MO, Boris RS. Impact of Obesity on Wound Complications Following Radical Prostatectomy Is Mitigated by Robotic Technique. J Endourol 2016; 30:890-5. [DOI: 10.1089/end.2016.0282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- M. Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kaitlin R. Jaqua
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam C. Calaway
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew J. Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael O. Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ronald S. Boris
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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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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Harbin AC, Eun DD. Anterior Approach to Robotic Radical Prostatectomy. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Causes of hospital readmissions after urologic cancer surgery. Urol Oncol 2015; 34:236.e1-11. [PMID: 26712365 DOI: 10.1016/j.urolonc.2015.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 09/15/2015] [Accepted: 11/17/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The Hospital Readmissions Reduction Program mandates reimbursement reductions to hospitals with higher than expected rates of readmissions. We examine causes and predictors of readmissions following major procedures in urologic oncology. MATERIALS AND METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, patients undergoing radical prostatectomy (RP), radical (RN) or partial nephrectomy (PN), and radical cystectomy (RC) during the year 2012 were abstracted. Rates of unplanned readmission within 30 days after surgery, as well as causes of readmission, were identified. Multivariable logistic regression models were fitted to examine the association between patient perioperative factors and odds of readmission. RESULTS Overall, we observed a 5.5% unplanned 30-day readmission rate. Readmission rates for patients treated with RP, RN, PN, and RC were 4.1%, 5.2%, 4.5%, and 15.9%, respectively. For each procedure, approximately two-third of readmissions occurred within the first 10 days following hospital discharge. Commonest causes of readmission after RP included thromboembolic (13.6%), wound (12.2%), renal/genitourinary (12.2%), and gastrointestinal (11.8%); after RN, wound (12.9%) and gastrointestinal (12.9%); after PN, renal/genitourinary (19.6%), cardiovascular (9.8%), and bleeding/hematoma (9.8%); and after RC, renal/genitourinary (15.5%), wound (14.8%), and sepsis/infection (14.1%). RC was significantly associated with readmission. Patients undergoing open RP or PN were more likely to be readmitted relative to their minimally invasive counterparts (odds ratio = 1.53, 95% CI: 1.12-2.08, P = 0.007 and odds ratio = 2.51, 95% CI: 1.38-4.55, P = 0.003, respectively). CONCLUSIONS Readmissions are relatively common following major urologic oncology procedures. Compared with RP, RN, or PN, RC patients experience the highest burden of readmission. Venous thromboembolism is a common modifiable cause of readmission following urologic cancer surgery. Minimally invasive approach is associated with decreased odds of readmission following RP and PN.
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Salomon L, Rozet F, Soulié M. La chirurgie du cancer de la prostate : principes techniques et complications péri-opératoires. Prog Urol 2015; 25:966-98. [DOI: 10.1016/j.purol.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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Chi AC, McGuire BB, Nadler RB. Modern Guidelines for Bowel Preparation and Antimicrobial Prophylaxis for Open and Laparoscopic Urologic Surgery. Urol Clin North Am 2015; 42:429-40. [PMID: 26475940 DOI: 10.1016/j.ucl.2015.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mechanical bowel preparation (MBP) and antibiotics (oral and/or intravenous) have historically been used to decrease infectious complications in surgeries that involve manipulation of bowel or potential risk of injury. The use of MBP has recently been challenged in the colorectal surgery literature, thus inspiring similar critical evaluation of our practices in urology. This review gives a brief overview of the history of mechanical and oral antibiotic bowel preparation, as well as the evolution of the practice trends in colorectal surgery and urology. We also examine contemporary guidelines in skin preparation as well as antimicrobial prophylaxis before surgery.
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Affiliation(s)
- Amanda C Chi
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Barry B McGuire
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Robert B Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Niklas C, Saar M, Berg B, Steiner K, Janssen M, Siemer S, Stöckle M, Ohlmann CH. da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs. Urol Int 2015; 96:287-94. [PMID: 26159050 DOI: 10.1159/000431104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/03/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. METHODS Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. RESULTS Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). CONCLUSIONS The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.
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Affiliation(s)
- Christina Niklas
- Saarland University Medical Center, Department of Urology and Pediatric Urology, Homburg/Saar, Germany
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Soares R, Di Benedetto A, Dovey Z, Bott S, McGregor RG, Eden CG. Minimum 5-year follow-up of 1138 consecutive laparoscopic radical prostatectomies. BJU Int 2015; 115:546-53. [PMID: 25098710 DOI: 10.1111/bju.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the long-term outcomes of laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS In all, 1138 patients underwent LRP during a 163-month period from 2000 to 2008, of which 51.5%, 30.3% and 18.2% were categorised into D'Amico risk groups of low-, intermediate- and high-risk, respectively. All intermediate- and high-risk patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning, and had a pelvic lymph node dissection (PLND), which was extended after April 2008. The median (range) patient age was 62 (40-78) years; body mass index was 26 (19-44) kg/m(2) ; prostate-specific antigen level was 7.0 (1-50) ng/mL and Gleason score was 6 (6-10). Neurovascular bundle was preservation carried out in 55.3% (bilateral 45.5%; unilateral 9.8%) of patients. RESULTS The median (range) gland weight was 52 (14-214) g. The median (range) operating time was 177 (78-600) min and PLND was performed in 299 patients (26.3%), of which 54 (18.0%) were extended. The median (range) blood loss was 200 (10-1300) mL, postoperative hospital stay was 3 (2-14) nights and catheterisation time was 14 (1-35) days. The complication rate was 5.2%. The median (range) LN count was 12 (4-26), LN positivity was 0.8% and the median (range) LN involvement was 2 (1-2). There was margin positivity in 13.9% of patients and up-grading in 29.3% and down-grading in 5.3%. While 11.4% of patients had up-staging from T1/2 to T3 and 37.1% had down-staging from T3 to T2. One case (0.09%) was converted to open surgery and six patients were transfused (0.5%). At a mean (range) follow-up of 88.6 (60-120) months, 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously potent non-diabetic men aged <70 years were potent after bilateral nerve preservation. CONCLUSIONS The long-term results obtainable from LRP match or exceed those previously published in large contemporary open and robot-assisted surgical series.
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Affiliation(s)
- Ricardo Soares
- Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK
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Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology 2015; 85:552-9. [PMID: 25733265 DOI: 10.1016/j.urology.2014.11.034] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urologic procedures to demonstrate background rates and discuss benchmarking. METHODS Urologic procedures from the National Surgical Quality Improvement Program (2006-2011) were analyzed to identify 30-day rates of 21 complications; outcomes (length of stay, reoperation, and death); and predictors including resident involvement for 18 specific procedures. Multivariate logistic regression models assessed predictors for any complication and for Clavien grade IV or V complication. RESULTS A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days length of stay and 3.2% mortality), with 56% experiencing any complication followed by nephrectomy (21%), retroperitoneal lymph node dissection (20%), and radical retropubic prostatectomy (19%). Transurethral resection of bladder tumor (11%) and transurethral resection of the prostate (10%) had the highest rates for endoscopic procedures. Older age, American Society of Anesthesiologists class, dependent functional status, acute kidney injury (odds ratio [OR], 2.70 [1.89-3.87]), and ≥5 units preoperative transfusion (OR, 4.44 [3.40-5.80]) were the strongest predictors of any complication. Higher ORs of similar predictors along with chronic obstructive pulmonary disorder (OR, 1.52 [1.21-1.92]) and steroid use (OR, 1.51 [1.07-2.14]) were associated with Clavien grade IV or V complication. Resident involvement increased odds of any complication (OR, 1.18 [1.09-1.29]), mostly for abdominopelvic and urogynecologic procedures, but not Clavien grade IV or V complication (P = .55). CONCLUSION Complication rates of urologic procedures based on the retrospective experience of few surgeons do not allow for appropriate benchmarking. Baseline rates and benchmarks derived from the National Surgical Quality Improvement Program may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).
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Autorino R, Zargar H, Butler S, Laydner H, Kaouk JH. Incidence and risk factors for 30-day readmission in patients undergoing nephrectomy procedures: a contemporary analysis of 5276 cases from the National Surgical Quality Improvement Program database. Urology 2015; 85:843-9. [PMID: 25681252 DOI: 10.1016/j.urology.2014.11.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/30/2014] [Accepted: 11/20/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore factors associated with readmission after nephrectomy procedures using a large national database. MATERIALS AND METHODS A national surgical outcomes database, the American College of Surgeon-National Surgical Quality Improvement Program registry, was queried for data on all patients undergoing open partial nephrectomy (OPN), minimally invasive (laparoscopic + robotic) partial nephrectomy (MIPN), and minimally invasive radical nephrectomy (MIRN) in 2011 and 2012. Patients undergoing these procedures were identified using the Current Procedural Terminology codes. The primary outcome was unplanned 30-day hospital readmission. A multivariate logistic regression model was constructed to assess for factors independently associated with the primary outcome. RESULTS Overall, 5276 cases were identified and included in the analysis: 1411 OPN (26.7%), 2210 MIPN (41.8%), and 1655 MIRN (31.3%). Overall, the 30-day readmission rate was 5.9% (7.8% for OPN, 4.5% for MIPN, and 6.1% for MIRN). On multivariate analysis, the odds for 30-day readmission for MIPN was approximately 70% that of OPN (P = .012). The odds for 30-day readmission for 2012 was about 80% of that of 2011 (P <.001). History of steroid use and of bleeding disorder and occurrence of postoperative transfusion increase the odds of readmission by approximately 2 (P = .005, P = .038, and P <.001, respectively). A postoperative urinary infection increased the odds of readmission by 5.5 (P <.001). CONCLUSION Contemporary 30-day readmission rates after nephrectomy procedures are influenced by specific patients' characteristics as well as postoperative adverse events. Moreover, contemporary MIPN seems to carry lower odds of readmission than OPN. It remains to be determined to what extent these findings are influenced by the expanding role of robotic technology.
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Affiliation(s)
- Riccardo Autorino
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Urology Institute, University Hospitals, Cleveland, OH
| | - Homayoun Zargar
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Sam Butler
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Humberto Laydner
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Urology Institute, University Hospitals, Cleveland, OH
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Open Conversion during Minimally Invasive Radical Prostatectomy: Impact on Perioperative Complications and Predictors from National Data. J Urol 2014; 192:1657-62. [DOI: 10.1016/j.juro.2014.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 12/29/2022]
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Korets R, Weinberg AC, Alberts BD, Woldu SL, Mann MJ, Badani KK. Utilization and Timing of Blood Transfusions Following Open and Robot-Assisted Radical Prostatectomy. J Endourol 2014; 28:1418-23. [DOI: 10.1089/end.2014.0225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ruslan Korets
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Aaron C. Weinberg
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Blake D. Alberts
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Solomon L. Woldu
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mark J. Mann
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ketan K. Badani
- Department of Urology, Columbia University Medical Center, New York, New York
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