Predictors of operative time during radical retropubic prostatectomy and robot-assisted laparoscopic prostatectomy

To better predict operative time using patient/surgical characteristics among men undergoing radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy in order to achieve more efficient operative scheduling and potentially decrease costs in the Veterans Health System.

We analyzed 2619 men treated with radical retropubic prostatectomy (n = 2005) or robot-assisted laparoscopic prostatectomy (n = 614) from 1993 to 2013 from six Veterans Affairs Hospitals in the Shared Equal Access Regional Cancer Hospital database. Age, body mass index, race, biopsy Gleason, prostate weight, undergoing a nerve-sparing procedure or lymph node dissection, and hospital surgical volume were analyzed in multivariable linear regression to identify predictors of operative time and to quantify the increase/decrease observed.

In men undergoing radical retropubic prostatectomy, body mass index, black race, prostate weight and a lymph node dissection all predicted longer operative times (all P ≤ 0.004). In men undergoing robot-assisted laparoscopic prostatectomy, biopsy Gleason score and a lymph node dissection were associated with increased operative time (P ≤ 0.048). In both surgical methods, a lymph node dissection added 25-40 min to the operation. Also, in both, each additional operation per year per center predicted a 0.80-0.89-min decrease in operative time (P ≤ 0.001).

Overall, several factors seem to be associated with quantifiable changes in operative time. If confirmed in future studies, these findings can allow for a more precise estimate of operative time, which could decrease the overall cost to the patient and hospital by aiding in operating room time management.

International journal of urology : official journal of the Japanese Urological Association. 2017 Jul 11 [Epub ahead of print]

Ross M Simon, Lauren E Howard, Daniel M Moreira, Martha K Terris, Christopher J Kane, William J Aronson, Christopher L Amling, Matthew R Cooperberg, Stephen J Freedland

Department of Urology, University of South Florida College of Medicine, Tampa, Florida, USA., Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA., Department of Urology, University of Illinois, Chicago, Illinois, USA., Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, Georgia, USA., Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, California, USA., Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, California, USA., Department of Urology, Oregon Health and Science University, Portland, Oregon, USA., Department of Urology, University of California at San Francisco, San Francisco, California, USA., Urology Section, Veterans Affairs Medical Center, Durham, North Carolina, USA.