title: Trends in radical prostatectomy: centralization, robotics, and access to urologic cancer care.
abstract: BACKGROUND
  Robotic surgery has been widely adopted for radical prostatectomy. We hypothesized that this change is rapidly shifting procedures away from hospitals that do not offer robotics and consequently increasing patient travel.
  
  
  METHODS
  A population-based observational study of all prostatectomies for cancer in New York, New Jersey, and Pennsylvania from 2000 to 2009 was performed using hospital discharge data. Hospital procedure volume was defined as the number of prostatectomies performed for cancer in a given year. Straight-line travel distance to the treating hospital was calculated for each case. Hospitals were contacted to determine the year of acquisition of the first robot.
  
  
  RESULTS
  From 2000 to 2009, the total number of prostatectomies performed annually increased substantially. The increase occurred almost entirely at the very high-volume centers (≥ 106 prostatectomies/year). The number of hospitals performing prostatectomy fell 37% from 2000 to 2009. By 2009, the 9% (21/244) of hospitals that had very high volume performed 57% of all prostatectomies, and the 35% (86/244) of hospitals with a robot performed 85% of all prostatectomies. The median travel distance increased 54% from 2000 to 2009 (P<.001). The proportion of patients traveling ≥ 15 miles increased from 24% to 40% (P < .001).
  
  
  CONCLUSIONS
  Over the past decade, the number of radical prostatectomies performed has risen substantially. These procedures have been increasingly centralized at high-volume centers, leading to longer patient travel distances. Few prostatectomies are now performed at hospitals that do not offer robotic surgery.
authors: Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599-7213, USA. stitz@med.unc.edu
authors: Karyn B
authors: KB
authors: Stitzenberg
authors: Yu-Ning
authors: YN
authors: Wong
authors: Matthew E
authors: ME
authors: Nielsen
authors: Brian L
authors: BL
authors: Egleston
authors: Robert G
authors: RG
authors: Uzzo
mesh_terms: D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends*; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000706:statistics & numerical data / Q000639:trends*; D014195:Travel; D055815:Young Adult