PMID- 32981194
OWN - NLM
STAT- MEDLINE
DCOM- 20211129
LR  - 20211129
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 128
IP  - 2
DP  - 2021 Aug
TI  - Perioperative outcomes and cost of robotic vs open simple prostatectomy in the 
      modern robotic era: results from the National Inpatient Sample.
PG  - 168-177
LID - 10.1111/bju.15258 [doi]
AB  - OBJECTIVES: To perform a comparative analysis of perioperative outcomes and 
      hospitalisation cost between open (OSP) and robot-assisted simple prostatectomy 
      (RASP) for treatment of benign prostatic hyperplasia (BPH) using the National 
      Inpatient Sample (NIS) in the contemporary robotic era. MATERIALS AND METHODS: 
      The NIS was queried for cases of OSP and RASP for the treatment of BPH between 
      2013 and 2016. Perioperative complications, unadjusted hospital cost and length 
      of stay (LOS) were compared between RASP and OSP. Smoothed linear regression 
      curves comparing hospitalisation cost by increasing LOS was stratified by 
      surgical approach to identify point of cost equivalency between RASP and OSP. 
      Multivariable linear regression analysis was used to construct a hospitalisation 
      cost model to examine the contribution of the robotic approach and LOS to 
      hospitalisation cost. RESULTS: The total analytical cohort included 2551 OSP and 
      704 RASP procedures. Patients undergoing RASP were younger, at a median 
      (interquartile range [IQR]) age of 68 (63-73) vs 71 (65-77) years, and with less 
      comorbidity (76.8% vs 86.5%, P < 0.01). RASP was associated with fewer total 
      complications (11.1% vs 29.2%, P < 0.01) and a greater likelihood of routine 
      discharge to home rather than another facility (88.9% vs 76.7%, P < 0.01). While 
      LOS was shorter with RASP (median [IQR], 2 [1-3] vs 4 [3-6] days, P < 0.01), 
      total unadjusted hospitalisation cost (in United States dollars) was greater 
      (median [IQR], $10 855 [$7965-$15 675] vs $13 467 [$10 572-$17 722], P < 0.01). 
      Presence of any complication increased both LOS and hospitalisation cost (P < 
      0.01). Linear regression modelling determined the point of cost equivalence 
      between RASP staying a median of 2 days was an OSP case staying between 5 and 
      6 days. On multivariable regression analysis, the robotic approach contributed an 
      additional $6175 (P < 0.01) to the cost model, whereas each additional day of 
      hospitalisation contributed $1687 (P < 0.01), suggesting LOS would need to be 
      3-4 days shorter with RASP to offset surgical costs of the robot. CONCLUSIONS: 
      While RASP appears to have significantly better perioperative complication rates 
      with shorter LOS and likely discharge to home, total hospitalisation cost 
      remained greater, likely related to upfront operative costs. While this 
      retrospective study is limited by selection bias for patients undergoing RASP, 
      the benefits of improved convalescence, discharge to home, and lower rate of 
      perioperative complications appear to justify performance of RASP in an 
      experienced pelvic robotic centre despite relatively greater hospitalisation cost 
      if referral to an experienced holmium laser enucleation of the prostate centre is 
      not feasible.
CI  - (c) 2020 The Authors BJU International (c) 2020 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Bhanvadia, Raj
AU  - Bhanvadia R
AUID- ORCID: 0000-0003-3462-376X
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Ashbrook, Caleb
AU  - Ashbrook C
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Gahan, Jeffery
AU  - Gahan J
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Mauck, Ryan
AU  - Mauck R
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Bagrodia, Aditya
AU  - Bagrodia A
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Margulis, Vitaly
AU  - Margulis V
AUID- ORCID: 0000-0002-5837-4561
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Lotan, Yair
AU  - Lotan Y
AUID- ORCID: 0000-0001-5692-2723
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Roehrborn, Claus
AU  - Roehrborn C
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
FAU - Woldu, Solomon
AU  - Woldu S
AD  - Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20201111
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Aged
MH  - *Costs and Cost Analysis
MH  - Hospitalization/*economics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prostatectomy/*economics/*methods
MH  - Prostatic Hyperplasia/*surgery
MH  - Retrospective Studies
MH  - Robotic Surgical Procedures/*economics
MH  - Treatment Outcome
MH  - United States
OTO - NOTNLM
OT  - #EndoUrology
OT  - #UroBPH
OT  - benign prostatic hyperplasia
OT  - hospitalisation cost
OT  - lower urinary tract symptoms
OT  - minimally invasive surgery
OT  - robot-assisted simple prostatectomy
EDAT- 2020/09/28 06:00
MHDA- 2021/11/30 06:00
CRDT- 2020/09/27 20:40
PHST- 2020/09/28 06:00 [pubmed]
PHST- 2021/11/30 06:00 [medline]
PHST- 2020/09/27 20:40 [entrez]
AID - 10.1111/bju.15258 [doi]
PST - ppublish
SO  - BJU Int. 2021 Aug;128(2):168-177. doi: 10.1111/bju.15258. Epub 2020 Nov 11.