National Multi-Institutional Comparison of 30-Day Postoperative Complication and Readmission Rates Between Open Retropubic Radical Prostatectomy and Robot-Assisted Laparoscopic Prostatectomy Using NSQIP

Pilecki, Matthew; McGuire, Barry B.; Jain, Umang; Kim, John Yah Sung; Nadler, Robert B.

doi:10.1089/end.2013.0656

Cited by 66 publications

(41 citation statements)

References 22 publications

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“…2 In the current Canadian study, the authors present their retrospective, single institution review of perioperative, oncological and functional outcomes for both ORP and RARP. 3,4 Interestingly at this tertiary academic high volume centre (The Vancouver Prostate Centre BC), their findings contrast to previously published outcomes. 5 More specifically, systemic reviews suggest that RARP is advantageous with regards to blood loss, transfusion rates and length of hospital stay.…”

contrasting

confidence: 87%

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Robot-assisted radical prostatectomy: Another Canadian experience

Valdivieso¹,

Zorn²

2014

CUAJ

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O ver the past decade, robot-assisted radical prostatectomy (RARP) has been gaining acceptance among patients and urologists. It has become the dominant surgical approach in the United States and other countries. Despite a paucity of prospective, randomized trials supporting its oncological or functional superiority over open radical prostatectomy (ORP), 1 parameters of reduced blood loss and transfusion, shorter hospital stay, reduced re-admission, re-operation, ureteral and rectal injuries, lymphocele and anastomotic leak, as well as overall reduced surgical morbidity, have favoured adoption of RARP. 2In the current Canadian study, the authors present their retrospective, single institution review of perioperative, oncological and functional outcomes for both ORP and RARP. 3,4 Interestingly at this tertiary academic high volume centre (The Vancouver Prostate Centre BC), their findings contrast to previously published outcomes.5 More specifically, systemic reviews suggest that RARP is advantageous with regards to blood loss, transfusion rates and length of hospital stay. In the study by Gagnon and colleagues, ORP and RARP blood loss (402 vs. 287 mL), transfusion rate (1.5% vs. 3.5%) and length of stay (1.95 vs. 1.69 days) were not found to be statistically significant (all p > 0.05). Furthermore, no differences in 90-day non-descriptive Clavien complications were observed. Moreover, in our initial robotic experience at the University of Montreal Hospital Centre in 2012, we compared perioperative outcomes of the first 200 RARP cases to 83 ORP cases performed in the same year (unpublished data). RARP men demonstrated significantly less blood loss (625 vs. 237mL; p < 0.01), transfusion (16.5% vs. 1.8%; p < 0.01) and length of stay (3.1 days vs. 1.4 days; p < 0.01). The incidence of perioperative 30-day complications was also higher in the ORP group (39% vs. 9%, p < 0.01). Similarly, in a large meta-analysis by Tewari and colleagues 2 of 167 184 ORP and 62 309 RARP cases from 400 original publications, the mean blood loss (745 vs. 188 mL, p < 0.01), transfusion rate (16.5% vs. 1.8%, p < 0.01) and length of stay (3.1 vs. 1.4d, p < 0.01) were all more favourable in RARP. In addition, rates for re-admission, re-operation, nerve, ureteral and rectal injury, deep vein thrombosis, pneumonia, hematoma, lymphocele, anastomotic leak, fistula, and wound infection showed significant differences favouring RARP over ORP.Two factors that may explain the discrepancy are surgeon experience and learning curve. A single surgeon (SLG), who did not undergo formal robotic fellowship training, performed the 200 consecutive RARP cases. It is noteworthy to highlight that only 70 cases were conducted before the study period. As such, the oncological learning curve of 200 (n = 4) cases was not reached for this surgeon and therefore, the comparison to a high-volume expert ORP surgeon could be considered unfair. More specifically, the reader should be aware that the single ORP surgeon (MEG) was fellowshiptrained at the MD Anderson Center an...

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contrasting

confidence: 87%

“…3,4 Interestingly at this tertiary academic high volume centre (The Vancouver Prostate Centre BC), their findings contrast to previously published outcomes.…”

contrasting

confidence: 66%

Robot-assisted radical prostatectomy: Another Canadian experience

Valdivieso¹,

Zorn²

2014

CUAJ

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“…During the last decade, these technical features of robotic surgery have led to increased acceptance of this surgical modality for complex interventions such as radical prostatectomy and convincing clinical outcomes have been reported in the international literature [3,4,12,13,14,15,16,17,18,19,20,21]. A systematic review of the international literature shows at least equivalent oncological outcomes [3,21], reduced intra- and perioperative complications [4], better functional outcomes [13,22], shorter hospital stays [17] and recovery [4] in the field of radical prostatectomy in comparison to the open procedure.…”

Section: Introductionmentioning

confidence: 99%

da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs

Niklas¹,

Saar²,

Berg³

et al. 2015

Urol Int

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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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“…In fact, according to this study, 3,170 patients (98.6%) had ≥ 6 hospital days after surgery. In addition, the median hospital period was 11 days longer than that (1-2 days) in the United States [5,22,24] . Therefore, our results provide more accurate and detailed data about perioperative complications.…”

Section: Discussionmentioning

confidence: 88%

Impact of Surgeon and Hospital Volume on the Safety of Robot-Assisted Radical Prostatectomy: A Multi-Institutional Study Based on a National Database

Hirasawa

Yoshioka

Nasu³

et al. 2017

Urol Int

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Introduction: We aimed to perform a multi-institutional study using a national database led by the Japanese Society of Endourology to investigate the effect of surgeon or hospital volume on the safety of robot-assisted radical prostatectomy (RARP). Materials and Methods: Clinical data of 3,214 patients who underwent RARP for the treatment of clinically localized prostate cancer between April 2012 and March 2013 in Japan were evaluated. Surgical outcomes and all intra- and perioperative complications were collected. Results: The intraoperative complication rate was 0.56%. In a total number of 241 patients, 261 perioperative complications were observed. The following percentages of patients presented the Clavien-graded complications: 7.2%, grades 1-2; 0.84%, grade 3; and 0.093%, grade 4a. No cases of multiple organ dysfunction or death (grades 4b and 5) were found. Multivariable logistic regression analysis showed that the hospital volume (OR 3.6; p = 0.010) for intraoperative complications and surgeon volume (OR 0.19; p < 0.0001) and extended lymph node discectomy (OR 3.9; p < 0.0001) for perioperative complications were significant independent risk factors. Conclusions: Hospital volume for intraoperative complications and surgeon volume and extended lymph node dissection for perioperative complications were significantly associated with increased risk of each complication in RARP.

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National Multi-Institutional Comparison of 30-Day Postoperative Complication and Readmission Rates Between Open Retropubic Radical Prostatectomy and Robot-Assisted Laparoscopic Prostatectomy Using NSQIP

Cited by 66 publications

References 22 publications

Robot-assisted radical prostatectomy: Another Canadian experience

Robot-assisted radical prostatectomy: Another Canadian experience

da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs

Impact of Surgeon and Hospital Volume on the Safety of Robot-Assisted Radical Prostatectomy: A Multi-Institutional Study Based on a National Database

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