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Kim SP , Gross CP , Smaldone MC , Han LC , Van Houten H , Lotan Y , Svatek RS , Thompson RH , Karnes RJ , Trinh QD , Kutikov A , Shah ND
Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: results from a privately insured patient population
Prostate Cancer Prostatic Dis. 2015 Mar;18(1) :13-7
PMID: 25311766   
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Abstract
BACKGROUND: With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer. METHODS: Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches. RESULTS: Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P<0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P<0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P<0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P=0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P<0.001). CONCLUSIONS: Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.
Notes
1476-5608 Kim, S P Gross, C P Smaldone, M C Han, L C Van Houten, H Lotan, Y Svatek, R S Thompson, R H Karnes, R J Trinh, Q-D Kutikov, A Shah, N D Journal Article England Prostate Cancer Prostatic Dis. 2015 Mar;18(1):13-7. doi: 10.1038/pcan.2014.38. Epub 2014 Oct 14.