Safety Profile of Robot-Assisted Radical Prostatectomy: A Standardized Report of Complications in 3317 Patients

Agarwal, Piyush K.; Sammon, Jesse D.; Bhandari, Akshay; Dabaja, Ali; Diaz, Mireya; Dusik-Fenton, Stacey; Satyanarayana, Ramgopal; Simone, Andrea; Trinh, Quoc Dien; Baize, Brad; Menon, Mani

doi:10.1016/j.eururo.2011.01.045

Cited by 119 publications

(83 citation statements)

References 23 publications

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“…18 Administrative data do not allow the standardized collection of complications, such as criteria defined by Martin and subsequently modified by Donat. [19][20][21][22] Specifically, claims data do not allow us to grade the severity of complications according to the Clavien classification. 23 Finally, our analyses focus on perioperative outcomes.…”

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confidence: 99%

Leapfrog volume thresholds and perioperative complications after radical prostatectomy

Trinh

Sun

Sammon

et al. 2012

Cancer

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BACKGROUND:The authors explored the effect of Leapfrog volume thresholds (LVTs) on 5 short-term radical prostatectomy (RP) outcomes. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), the authors focused on RPs performed within the 7 most contemporary years (2001)(2002)(2003)(2004)(2005)(2006)(2007). They tested rates of in-hospital mortality, intraoperative complications, postoperative complications, and blood transfusions as well as the mean length of stay (LOS), stratified according to the number of LVTs that were met. Multivariable regression analyses were adjusted further for potential confounders. RESULTS: Overall, 36.2%, 17.3%, 14.9%, 15.7%, 12.9%, and 3% of RPs were performed at institutions that reached 0 LVT, 1 LVT, 2 LVTs, 3 LVTs, 4 LVTs, and 5 LVTs, respectively. Relative to patients who underwent RP at institutions that reached 0 LVTs, patients who underwent RP at institutions that reached 5 LVTs had fewer comorbidities, were younger, were more likely to hold private insurance, and were more likely to undergo concomitant pelvic lymphadenectomy (all P < .001). In multivariable analyses adjusted for hospital volume (HV), age, race, year of surgery, Charlson Comorbidity Index, hospital region and location, pelvic lymphadenectomy, and insurance status, LVT status was related inversely to LOS and the likelihood of receiving blood transfusions (both P < .001). CONCLUSIONS: The current results indicated that LVTs can provide a highly accurate prediction of the probability of 2 important, detrimental, short-term outcomes after RP, even after accounting for HV. The benefit at institutions that meet LVTs may exceed that at other institutions when short-term RP outcomes are considered. This observation should be taken into consideration when treatment decisions are made, especially because most RPs were performed at institutions that did not meet any LVTs. Cancer 2012;118:4991-8.

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confidence: 99%

Leapfrog volume thresholds and perioperative complications after radical prostatectomy

Trinh

Sun

Sammon

et al. 2012

Cancer

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“…Moreover, based on cost-control considerations, some institutions may encourage MIRPs while others may prioritize ORPs. Although many institutional series have reported superior outcomes of MIRP, 19 concerns regarding late complications, 20 steeper learning curve, 21 and cost-effectiveness 22 have been raised. Nonetheless, Abdollah et al showed that total hospital charges are substantially lower when MIRPs are performed by high-volume surgeons versus low-volume surgeons.…”

Section: Discussionmentioning

confidence: 99%

Improvement of racial disparities with respect to the utilization of minimally invasive radical prostatectomy in the United States

Trinh

Schmitges

Sun

et al. 2011

Cancer

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BACKGROUND: Race represents an established barrier to health care access in the United States and elsewhere. We examined whether race affects the utilization rate of minimally invasive radical prostatectomy (MIRP) in a population‐based sample of individuals from the United States. METHODS: Within the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom MIRP and open radical prostatectomy (ORP) were performed between 2001 and 2007. We assessed the proportions and temporal trends in race distributions between MIRP and ORP. Multivariable logistic regression analyses further adjusted for age, year of surgery, baseline Charlson Comorbidity Index, annual hospital caseload tertiles, hospital region, insurance status, and median zip code income. RESULTS: Of 65,148 radical prostatectomies, 3581 (5.5%) were MIRPs. African Americans accounted for 11.4% of patients versus 78.8% for Caucasians versus 9.9% for others. Between 2001 and 2007, the annual proportions of Caucasian patients treated with MIRP were 2.2%, 0.9%, 2.6%, 7.2%, 4.7%, 9.3%, and 11.6%, respectively (chi‐square trend p<0.001). For the same years in African American patients, the proportions were 0.8, 0.3, 1.4, 4.4, 3.5, 9.0 and 8.4% (chi‐square trend P < .001). In multivariable analyses relative to Caucasian patients, African American patients were 14% less likely to undergo MIRP (P = .01). After period stratification between years 2001‐2005 versus 2006‐2007, African Americans were 22% less likely to undergo a MIRP in the early period (P = .007) versus 11% less likely to have a MIRP in the contemporary period (P = .1). CONCLUSIONS: The racial discrepancies in MIRP utilization rates are gradually improving. Cancer 2012;. © 2011 American Cancer Society.

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“…Refer to Table 1 for a review of complications in the studies comparing RALRP and ORP. [33][34][35][36][37] Agarwal et al 38 reported on 3,317 consecutive study patients who underwent RALRP at a single institution between 2005 and 2009 and found an overall complication rate of 10%. The majority of complications occurred within 30 days.…”

Section: Complicationsmentioning

confidence: 99%

“…The majority of complications occurred within 30 days. 38 A total of 2.1% of patients received a perioperative blood transfusion, 2% had postoperative bleeding, 1% had urine leaks, and 0.3% had venous thromboembolism. 38 Nine study patients also had enterotomies during surgery that required repair.…”

Section: Complicationsmentioning

confidence: 99%

“…38 A total of 2.1% of patients received a perioperative blood transfusion, 2% had postoperative bleeding, 1% had urine leaks, and 0.3% had venous thromboembolism. 38 Nine study patients also had enterotomies during surgery that required repair. 38 These findings were confirmed in a recent meta-analysis by Novara et al 39 ; the rates of blood loss and transfusions alone were significantly different between the RALRP and ORP groups, although the groups undergoing RALRP had lower values in both categories.…”

Section: Complicationsmentioning

confidence: 99%

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Robotic-Assisted Laparoscopic Radical Prostatectomy

et al. 2015

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Safety Profile of Robot-Assisted Radical Prostatectomy: A Standardized Report of Complications in 3317 Patients

Cited by 119 publications

References 23 publications

Leapfrog volume thresholds and perioperative complications after radical prostatectomy

Leapfrog volume thresholds and perioperative complications after radical prostatectomy

Improvement of racial disparities with respect to the utilization of minimally invasive radical prostatectomy in the United States

Robotic-Assisted Laparoscopic Radical Prostatectomy

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