Prior to the introduction and dissemination of robot-assisted radical prostatectomy
(RARP), population-based studies comparing open radical prostatectomy (ORP) and minimally
invasive radical prostatectomy (MIRP) found no clinically significant difference in
perioperative complication rates.
Assess the rate of RARP utilization and reexamine the difference in perioperative
complication rates between RARP and ORP in light of RARP's supplanting laparoscopic
radical prostatectomy (LRP) as the most common MIRP technique.
As of October 2008, a robot-assisted modifier was introduced to denote robot-assisted
procedures. Relying on the Nationwide Inpatient Sample between October 2008 and December
2009, patients treated with radical prostatectomy (RP) were identified. The robot-assisted
modifier (17.4x) was used to identify RARP (n=11 889). Patients with the minimally
invasive modifier code (54.21) without the robot-assisted modifier were classified
as having undergone LRP and were removed from further analyses. The remainder were
classified as ORP patients (n=7389).
All patients underwent RARP or ORP.
We compared the rates of blood transfusions, intraoperative and postoperative complications,
prolonged length of stay (pLOS), and in-hospital mortality. Multivariable logistic
regression analyses of propensity score-matched populations, fitted with general estimation
equations for clustering among hospitals, further adjusted for confounding factors.
Of 19 462 RPs, 61.1% were RARPs, 38.0% were ORPs, and 0.9% were LRPs. In multivariable
analyses of propensity score-matched populations, patients undergoing RARP were less
likely to receive a blood transfusion (odds ratio [OR]: 0.34; 95% confidence interval
[CI], 0.28-0.40), to experience an intraoperative complication (OR: 0.47; 95% CI,
0.31-0.71) or a postoperative complication (OR: 0.86; 95% CI, 0.77-0.96), and to experience
a pLOS (OR: 0.28; 95% CI, 0.26-0.30). Limitations of this study include lack of adjustment
for tumor characteristics, surgeon volume, learning curve effect, and longitudinal
RARP has supplanted ORP as the most common surgical approach for RP. Moreover, we
demonstrate superior adjusted perioperative outcomes after RARP in virtually all examined
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