title: Hospital volume, utilization, costs and outcomes of robot-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  Although robot-assisted laparoscopic radical prostatectomy has been aggressively marketed and rapidly adopted, there is a paucity of population based utilization, outcome and cost data. High vs low volume hospitals have better outcomes for open and minimally invasive radical prostatectomy (robotic or laparoscopic) but to our knowledge volume outcomes effects for robot-assisted laparoscopic radical prostatectomy alone have not been studied.
  
  
  METHODS
  We characterized robot-assisted laparoscopic radical prostatectomy outcome by hospital volume using the Nationwide Inpatient Sample during the last quarter of 2008. Propensity scoring methods were used to assess outcomes and costs.
  
  
  RESULTS
  At high volume hospitals robot-assisted laparoscopic radical prostatectomy was more likely to be done on men who were white with an income in the highest quartile and age less than 50 years than at low volume hospitals (each p <0.01). Hospitals at above the 50th volume percentile were less likely to show miscellaneous medical and overall complications (p = 0.01). Low vs high volume hospitals had longer mean length of stay (1.9 vs 1.6 days) and incurred higher median costs ($12,754 vs $8,623, each p <0.01).
  
  
  CONCLUSIONS
  Demographic differences exist in robot-assisted laparoscopic radical prostatectomy patient populations between high and low volume hospitals. Higher volume hospitals showed fewer complications and lower costs than low volume hospitals on a national basis. These findings support referral to high volume centers for robot-assisted laparoscopic radical prostatectomy to decrease complications and costs.
authors.affiliation: Division of Urology, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Hua-Yin
authors.initials: HY
authors.lastname: Yu
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D006306:Health Surveys; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011468:Prostatectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D012371:Robotics / Q000191:economics; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D014481:United States