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Walsan R, Mitchell RJ, Braithwaite J, Westbrook J, Hibbert P, Mumford V, Harrison R. Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia. AUST HEALTH REV 2024; 48:167-171. [PMID: 38479795 DOI: 10.1071/ah24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Abstract
Objectives Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs.
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Affiliation(s)
- Ramya Walsan
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia; and IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
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2
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Zukiwskyj M, Nicol A, Heathcote P. Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter? J Robot Surg 2024; 18:61. [PMID: 38308726 DOI: 10.1007/s11701-023-01816-3] [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: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
The incidence of incisional hernia (IH) following robotic-assisted laparoscopic prostatectomy (RALP) varies widely within the literature (0.4-9.7%). Whilst small hernias may go unnoticed, the potential exists for bowel strangulation and subsequent emergency surgery. We suggest that the extraction site may influence the rate of IH. A retrospective chart review of a single surgeon RALP series was undertaken. One hundred charts were sampled, of which 69 had sufficient data to be analysed. Prior to July 2017, specimen extraction had been via the supra-umbilical port site. After this time, specimens were extracted via a Pfannenstiel incision. Of the 69 patients, 24 underwent RALP prior to July 2017. Three patients developed IH at the supra-umbilical port extended for extraction site in the pre-2017 group and three patients developed IH at the supra-umbilical port (not extraction) site in the post-2017 group. The rate of IH was almost double in the pre-July 2017 group (12.5% vs. 6.7%). No patient developed an incisional hernia at the Pfannenstiel site in the post-2017 group. In our series, no patient developed a hernia at the Pfannenstiel site. This is in keeping with the reported < 1% IH rate following Pfannenstiel specimen extraction. Given that incisional hernias are a known complication of robotic surgery, thought should be given to changing the site of specimen extraction site to lower the rate of incisional hernias and the morbidity associated with such.
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Affiliation(s)
- Marianna Zukiwskyj
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Alice Nicol
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Peter Heathcote
- Greenslopes Hospital, Newdegate Street, Greenslopes, QLD, 4121, Australia
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3
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Abou Heidar NF, Ayoub CH, Abou Mrad A, Abdul Khalek J, Tamim H, El-Hajj A. Robotic-assisted radical prostatectomy is pushing the boundaries: a national survey of frailty using the national surgical quality improvement program. Ther Adv Urol 2023; 15:17562872231177780. [PMID: 37325291 PMCID: PMC10265338 DOI: 10.1177/17562872231177780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Background Robotic-assisted radical prostatectomy (RARP) has been found to be comparable and, in some cases, favorable to open surgical approaches, while being used in a frailer population. Objectives We aimed to illustrate the trend in population frailty and compare morbidity and mortality postoperatively in patients who underwent RARP. Design and Methods The National Surgical Quality Improvement Program data set was used to select patients who underwent RARP between the years 2011-2019. Age, frailty indicators, surgical characteristics, and perioperative morbidity and mortality were compared between the years 2011-2019 using the chi-square test (χ2) for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables. Results Our patient population consisted of 66,683 patients who underwent RARP. There was an increase in mean age and frailty indicated by an increase in 5-item frailty score ⩾2, metabolic syndrome index = 3, and American Society of Anesthesiologists' (ASA) class ⩾3 between the years 2011-2019 (p < 0.001). Whereas the rate of mortality and morbidity, indicated by postoperative Clavien-Dindo grade ⩾4 and major morbidity, remained the same over the same period (p > 0.264). Furthermore, operative time and length of stay decreased over the same period (p < 0.001). Conclusion RARP is being performed on more frail patients, with no added morbidity or mortality.
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Affiliation(s)
| | | | | | | | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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4
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Papa N, Perera M, Bensley JG, Evans M, Millar J, Frydenberg M, Murphy DG, Bolton D. A decade of declining prostatectomy margin positivity within a prostate cancer clinical quality registry. Urol Oncol 2022; 40:537.e19-537.e24. [PMID: 36167774 DOI: 10.1016/j.urolonc.2022.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/28/2022] [Indexed: 01/13/2023]
Abstract
CONTEXT Positive surgical margin (PSM) on radical prostatectomy (RP) is associated with an increased risk of biochemical recurrence and use of salvage therapies. Given these adverse consequences, exploration of time trends and predictors of PSM will improve the patient outcomes following surgery for prostate cancer. METHODS Pathological data from RP patients treated from 2011 to 2020 was extracted from the Victorian Prostate Cancer Outcomes Registry. This is a clinical quality registry that regularly benchmarks and reports back to individual clinicians the PSM percentage for their patients. Trends in PSM over time were visualized with separate running mean plots for both pT2 and pT3/4 disease. Predictors of PSM were explored with multivariable regression with date of surgery, surgical method, and hospital type, public or private, entered as covariates. RESULTS In total, 12,394 patients formed the sample with PSM recorded in 25% (n = 3,141) of patients, 12% (777/6,640) in pT2 disease and 41% (2,364/5,754) in pT3/4 disease. Comparing 2011-12 to 2019-20, the pT3/4 PSM proportion declined from 50% to 38% while pT2 percentages were steady at 13%. In "high volume" institutions, pT2 PSM fell from 12% to 6.5%. Independent predictors of lower PSM were robotic vs. open method and being treated at a private vs. public institution. CONCLUSION A clear decline in the proportion of pT3 PSM was observed in a large prostate cancer registry. Proposed explanatory factors include improved technical proficiency with robotic surgery and participation in a registry-based quality improvement initiative.
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Affiliation(s)
- Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Australia; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan G Bensley
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Melanie Evans
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jeremy Millar
- School of Public Health and Preventive Medicine, Monash University, Australia; Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Australia; Prostate Cancer Research Program, Faculty of Nursing, Medicine & Health Sciences, Monash University, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Australia
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5
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Bolton D, Hong A, Papa N, Perera M, Kelly B, Duncan C, Clouston D, Lawrentschuk N. Cribriform pattern disease over‐represented in pelvic lymph node metastases identified on
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GA PSMA‐PET/CT. BJUI COMPASS 2022; 3:371-376. [PMID: 35950036 PMCID: PMC9349597 DOI: 10.1002/bco2.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives To determine whether any specific histologic subtype of prostate cancer was preferentially represented in pelvic lymph node metastases identified on 68GA‐PSMA‐PET/CT. Subjects and Methods A consecutive series of 66 men with biochemical recurrent prostate cancer was evaluated with 68GA‐PSMA‐PET/CT. Where disease was confined to pelvic lymph nodes, patients were offered salvage extended pelvic lymph node dissection. Twenty patients ultimately proceeded to extended bilateral template pelvic lymph node dissection. Lymph node positivity and the histologic subtype of apparent cancer were assessed, as was PSA response to this intervention. Results Mean PSA at time of PSMA scanning for patients undergoing lymphadenectomy was 2.49 (n = 20, range 0.21–12.0). In 16 of 20 patients, there was evidence of metastatic cribriform pattern prostate cancer in excised nodes (100% cribriform pattern in 11/16). Only four of 20 patients had no evidence of this histologic subtype of disease. PSA response was not related to the presence or proportional amount of cribriform pattern disease identified. Conclusions Cribriform pattern adenocarcinoma appears to be the histologic subtype preferentially identified in pelvic lymph nodes on 68GA‐PSMA‐PET/CT. The use of PSMA‐PET may be particularly valuable in staging of primary or biochemically recurrent prostate cancer in patients with cribriform pattern disease detected on initial biopsy or radical prostatectomy. Further research is required to further confirm the observed association.
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Affiliation(s)
- Damien Bolton
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
| | - Anne Hong
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
| | - Nathan Papa
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
- Department of Preventive Medicine Monash University Melbourne Australia
| | - Marlon Perera
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
- Urology Service, Department of Surgery Memorial Sloan Kettering Cancer Center New York New York USA
| | - Brian Kelly
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
- Department of Urology Peter MacCallum Cancer Centre Melbourne Australia
| | - Catriona Duncan
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
| | | | - Nathan Lawrentschuk
- Department of Urology and University of Melbourne Department of Surgery Austin Health Melbourne Australia
- Department of Urology Peter MacCallum Cancer Centre Melbourne Australia
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6
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Gabrielson AT, Clifton MM, Pavlovich CP, Biles MJ, Huang M, Agnew J, Pierorazio PM, Matlaga BR, Bajic P, Schwen ZR. Surgical ergonomics for urologists: a practical guide. Nat Rev Urol 2021; 18:160-169. [PMID: 33432182 DOI: 10.1038/s41585-020-00414-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
Poor ergonomics in the operating room can have detrimental effects on a surgeon's physical, psychological and economic well-being. This problem is of particular importance to urologists who are trained in nearly all operative approaches (open, laparoscopic, robotic-assisted, microscopic and endoscopic surgery), each with their own ergonomic considerations. The vast majority of urologists have experienced work-related musculoskeletal pain or injury at some point in their career, which can result in leaves of absence, medical and/or surgical treatment, burnout, changes of specialty and even early retirement. Surgical ergonomics in urology has been understudied and underemphasized. In this Review, we characterize the burden of musculoskeletal injury in urologists and focus on various ergonomic considerations relevant to the urology surgeon. Although the strength of evidence remains limited in this space, we highlight several practical recommendations stratified by operative approach that can be incorporated into practice without interrupting workflow whilst minimizing injury to the surgeon. These recommendations might also serve as the foundation for ergonomics training curricula in residency and continuing medical education programmes. With improved awareness of ergonomic principles and the sequelae of injury related to urological surgery, urologists can be more mindful of their operating room environment and identify ways of reducing their own symptoms and risk of injury.
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Affiliation(s)
- Andrew T Gabrielson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marisa M Clifton
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitchell Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacqueline Agnew
- Department of Environmental Health and Engineering, Johns Hopkins Education and Research Center for Occupational Safety and Health, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian R Matlaga
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad R Schwen
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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7
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Abstract
Radical prostatectomy (RP) is a common treatment choice for localized prostate cancer. While there is increasing utilisation of robotic assisted RP in some centres, open RP (ORP) remains well established and commonly performed in many parts of the world. The goals of modern ORP are to remove the prostate en-bloc with negative surgical margins, while minimising blood loss and preserving urinary continence and erectile function. We present a technical review of ORP incorporating contemporary techniques for control of the deep venous complex, additional haemostatic measures, nerve-sparing and vesicourethral reconstruction.
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Affiliation(s)
- Ryan Pereira
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andre Joshi
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Queensland University of Technology, Australian Prostate Cancer Research Centre, Brisbane, Queensland, Australia
| | - Matthew Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Nepean Urology Research Group, Kingswood, Australia
| | - John Yaxley
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Queensland University of Technology, Australian Prostate Cancer Research Centre, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
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8
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Morton A, Williams M, Perera M, Teloken PE, Donato P, Ranasinghe S, Chung E, Bolton D, Yaxley J, Roberts MJ. Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data. BJU Int 2020; 126 Suppl 1:18-26. [PMID: 32558340 DOI: 10.1111/bju.15098] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. PATIENTS AND METHODS Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000-2018. Population-adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. RESULTS Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. CONCLUSION Despite reduced national BPH-related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.
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Affiliation(s)
- Andrew Morton
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Michael Williams
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marlon Perera
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick E Teloken
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Peter Donato
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sachinka Ranasinghe
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Eric Chung
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Andro Urology Centre, Brisbane, Queensland, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John Yaxley
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia.,Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
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9
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Zhong W, Roberts MJ, Saad J, Thangasamy IA, Arianayagam R, Sathianathen NJ, Gendy R, Goolam A, Khadra M, Arianayagam M, Varol C, Ko R, Canagasingham B, Ferguson R, Winter M. A Systematic Review and Meta-Analysis of Pelvic Drain Insertion After Robot-Assisted Radical Prostatectomy. J Endourol 2020; 34:401-408. [DOI: 10.1089/end.2019.0554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Wenjie Zhong
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Matthew J. Roberts
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Jeremy Saad
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Isaac A. Thangasamy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Australia
| | | | | | - Rasha Gendy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Ahmed Goolam
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Mohamed Khadra
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Mohan Arianayagam
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Celi Varol
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Raymond Ko
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | - Richard Ferguson
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia
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10
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Roberts MJ, Papa N, Perera M, Scott S, Teloken PE, Joshi A, Vela I, Pryor D, Martin J, Woo H. A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer. BJU Int 2019; 124 Suppl 1:31-36. [DOI: 10.1111/bju.14773] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Matthew J. Roberts
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Nepean Urology Research Group; Kingswood NSW Australia
| | - Nathan Papa
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Susan Scott
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Patrick E. Teloken
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Andre Joshi
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - Ian Vela
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - David Pryor
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | | | - Henry Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
- Department of Uro-Oncology; Chris O'Brien Lifehouse; Sydney NSW Australia
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11
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Ali S, Ahn T, Papa N, Perera M, Teloken P, Coughlin G, Wood ST, Roberts MJ. Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data. ANZ J Surg 2019; 90:48-52. [PMID: 31478323 DOI: 10.1111/ans.15385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.
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Affiliation(s)
- Stephen Ali
- Department of Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Teloken
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Geoffrey Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia
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