title: Comparisons of perioperative outcomes and costs between open and laparoscopic radical prostatectomy: a propensity-score matching analysis based on the Japanese Diagnosis Procedure Combination database.
abstract: We compared perioperative outcomes and costs between open and laparoscopic radical prostatectomy for prostate cancer. The Japanese Diagnosis Procedure Combination database, including cases from 2007 to 2010, was used by one-to-one propensity-score matching. The following items were compared: complication rate; homologous and autologous transfusion rate; first cystography day and cystography repeat rate; anesthesia time; postoperative length of stay; and costs. Multivariate analyses were carried out by including age, Charlson Comorbidity Index, T stage, hospital volume and hospital academic status as variables. As a result, among 15 616 open and 1997 laparoscopic radical prostatectomies, 1627 propensity-score matched pairs were generated. The laparoscopic approach showed a better overall complication rate (3.4% vs 5.0%), homologous transfusion rate (3.3% vs 9.2%), autologous transfusion rate (44.9% vs 79.3%), first cystography day (mean 6th vs 7th day), mean postoperative length of stay (mean 11 vs 13 days), and cost without surgery and anesthesia (mean $7965 vs $9235; all P < 0.001). Anesthesia time was longer (mean 345 vs 285 min) and total cost was higher (mean $14 980 vs $12 356) for the laparoscopic approach (both P < 0.001). The secondary cystography rates were comparable between the groups (18.3% vs 15.7%, P = 0.144). The multivariate analyses showed similar trends. In conclusion, these findings confirm several benefits of laparoscopy over open approach for radical prostatectomy.
authors: Department of Urology, Shintoshi Hospital, Iwata, Japan. ezy04707@nifty.com
authors: Toru
authors: T
authors: Sugihara
authors: Hideo
authors: H
authors: Yasunaga
authors: Hiromasa
authors: H
authors: Horiguchi
authors: Nobuo
authors: N
authors: Tsuru
authors: Hiroyuki
authors: H
authors: Ihara
authors: Tetsuya
authors: T
authors: Fujimura
authors: Hiroaki
authors: H
authors: Nishimatsu
authors: Kazuhiko
authors: K
authors: Ohe
authors: Kiyohide
authors: K
authors: Fushimi
authors: Yukio
authors: Y
authors: Homma
mesh_terms: D000368:Aged; D000758:Anesthesia; D001804:Blood Transfusion, Autologous; D016009:Chi-Square Distribution; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D057216:Propensity Score; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011859:Radiography; D018709:Statistics, Nonparametric; D013997:Time Factors; D001743:Urinary Bladder / Q000000981:diagnostic imaging