title: A population-based analysis of temporal perioperative complication rates after minimally invasive radical prostatectomy.
abstract: BACKGROUND
  Existing population-based reports on complication rates after minimally invasive radical prostatectomy (MIRP) did not address temporal trends.
  
  
  OBJECTIVE
  To examine contemporary temporal trends in perioperative MIRP outcomes.
  
  
  METHODS
  Between 2001 and 2007, 4387 patients undergoing MIRP were identified using the Nationwide Inpatient Sample.
  
  
  METHODS
  To examine the rates and trends of intraoperative and postoperative complications, transfusion rates, length of stay in excess of the median, and in-hospital mortality. We tested the effect of the late (2006-2007) versus the early (2001-2005) study period on all outcomes using multivariable logistic regression models controlled for clustering among hospitals.
  
  
  CONCLUSIONS
  Intraoperative and postoperative complications decreased from 7.0% to 0.8% (p < 0.001) and from 28.5% to 8.7% (p < 0.001), respectively. Transfusion rates decreased from 3.5% to 2.1% (p = 0.3). Hospital length of stay >2 d decreased from 56% to 15% (p < 0.001). In multivariable analyses, intraoperative (odds ratio [OR]: 0.41; p = 0.002) and postoperative (OR: 0.65; p = 0.007) complications were less frequent in the late versus the early study period. Late study period patients were less likely to stay >2 d than early study period patients (OR: 0.34; p > 0.001). Limitations of these findings include the lack of adjustment for several patient variables including disease characteristics, surgeon variables including surgeon caseload, and the restriction to in-hospital events.
  
  
  CONCLUSIONS
  Our analyses demonstrate that in-hospital complication rates and length of stay after MIRP decreased over time. This implies that temporal differences specific to complication rates after MIRP must be considered when comparisons are made with other radical prostatectomy techniques.
authors: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. janschmitges@gmx.de
authors: Jan
authors: J
authors: Schmitges
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Firas
authors: F
authors: Abdollah
authors: Maxine
authors: M
authors: Sun
authors: Marco
authors: M
authors: Bianchi
authors: Lars
authors: L
authors: Budäus
authors: Kevin
authors: K
authors: Zorn
authors: Paul
authors: P
authors: Perotte
authors: Thorsten
authors: T
authors: Schlomm
authors: Alexander
authors: A
authors: Haese
authors: Francesco
authors: F
authors: Montorsi
authors: Mani
authors: M
authors: Menon
authors: Markus
authors: M
authors: Graefen
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011468:Prostatectomy / Q000009:adverse effects* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology