Cost comparison of radical retropubic and radical perineal prostatectomy: single institution experience.
OBJECTIVE
To perform a detailed comparison of the in-house hospital costs of patients undergoing radical perineal prostatectomy (RPP) and radical retropubic prostatectomy (RRP) performed with or without bilateral staging lymph node dissection (BPLND) for localized prostate cancer.


METHODS
A retrospective cost review was done of a cohort of 402 consecutive radical prostatectomies performed at our institution during a 21-month period. The procedure was performed as RPP in 279 (69.4%) and RRP in 123 (30.6%) patients, of whom 10.4% and 61.8%, respectively, underwent BPLND under the same anesthesia. The hospital costs were evaluated for each patient using the categories of surgical, nursing, laboratory/transfusion, and pharmacy. Surgical costs were further subdivided into operating room, anesthesia, and recovery room costs. Univariate and multivariate statistical analyses were applied to identify predictors of procedure-related costs.


RESULTS
The median hospital costs of patients undergoing RPP (7195 dollars, range 5052 dollars to 36,237 dollars) were substantially lower than those of patients undergoing RRP (9757 dollars, range 6935 dollars to 27,771 dollars; P = 0.001). The median costs for patients undergoing radical prostatectomy without BPLND were significantly lower in the RPP (7100 dollars, range 5052 dollars to 28,604 dollars) versus RRP (9169 dollars, range 6935 dollars to 16,705 dollars) patients (P = 0.001). The costs for RPP with BPLND (10,048 dollars, range 7529 dollars to 36,237 dollars) versus RRP with BPLND (9973 dollars, range 7658 dollars to 27,771 dollars) were not significantly different (P = 0.900). Patient age and nerve-preservation status did not significantly influence the procedure-related hospital costs.


CONCLUSIONS
RPP may result in lower in-house costs per patient than RRP in those patients who do not require BPLND. Total hospital costs depend largely on the factors of operating room time, length of stay, and laboratory and transfusion requirements, which may vary among institutions.
Silverstein
Ari D
AD
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Weizer
Alon Z
AZ
Dowell
Jeannette M
JM
Auge
Brian K
BK
Paulson
David F
DF
Dahm
Philipp
P
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D010502:Perineum / Q000601:surgery; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000191:economics* / Q000379:methods; D011471:Prostatic Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies