In the United States, robot-assisted radical prostatectomy (RARP) is the most common approach for the operative management of prostate cancer (PCa).
Patients pursue robotic surgery based on perceived benefit, but fail to take into account the importance of institution and surgeon volume on outcomes. Therefore, we examined the Nationwide Inpatient Sample (NIS) to elucidate the extent of robotic diffusion for PCa surgery, and to explore the effects of wider robotic adoption on prostatectomy complication rates. NIS patients who underwent RARP between 2009 and 2011 were included. Hospital volume was calculated and complications were recorded. The effect of hospital volume quintile was assessed with ordinal logistic regression fitted with generalized estimating equations to control for hospital clustering and was adjusted for various confounders. Results show median hospital volume fell sharply after 2009. Overall postoperative complication rates at very-low volume institutions (14.7%) versus very-high volume institutions (5.7%) were significant, and patients treated at very-high volume hospitals were less than half as likely to experience a complication (OR: 0.40; 95% CI: 0.29-0.54). In conclusion, migration of patients away from very-high volume institutions is likely jeopardizing patient care, and a renewed focus on the benefits of centralization of care is warranted.
Sammon JD, Abdollah F, Klett DE, Pucheril D, Sood A, Trinh QD, Menon M. Are you the author?
Vattikuti Urology Institute, Center for Outcomes Research Analytics & Evaluation, Henry Ford Health System.
Reference: BJU Int. 2015 Mar 6. Epub ahead of print.