title: Positioning-related complications of minimally invasive radical prostatectomies.
abstract: OBJECTIVE
  Because of recent advances in minimally invasive surgical techniques, robot-assisted radical prostatectomy (RARP) has become the primary treatment option in prostate cancer. RARP, however, necessitates patients to be placed in a steep Trendelenberg position, which presents multiple opportunities for complications relating to the positioning of the patient. Our study aims to study the prevalence and demographic predictors of these positioning complications and assess their impacts on length of stay (LOS) and total cost.
  
  
  METHODS
  We included patients who underwent RP from 2008 to 2009 using data extracted from the Nationwide Inpatient Sample database. Positioning complications (eye, nerve, compartment syndrome/rhabdomyolysis) were identified using patient-level diagnosis and procedural International Classification of Disease, 9th edition, Clinical Modification codes. Logistic regression models assessed relationships between demographic factors and occurrence of complications and the effects of them on prolonged LOS and total inpatient cost.
  
  
  RESULTS
  Positioning complications occurred in 0.4% of cases with eye complications contributing the most to this frequency. Laparoscopic RP procedure (odds ratio [OR]=2.88, P<0.01) and comorbidities (OR=2.34, P<0.01) were highly associated with increased odds of positioning complication occurrence, whereas RARP procedures (OR=0.93, P>0.4) were not associated with positioning complications. Having positioning complications increased a patient's odds of having increased inpatient costs and extended LOS by almost 400% and 300%, respectively.
  
  
  CONCLUSIONS
  The steep Trendelenberg position used in RARP was not shown to be associated with patient positioning-related complications in this sample. The occurrence of positioning-related complications, however, places huge burdens on total inpatient costs and LOS.
authors.affiliation: 1 Department of Epidemiology, Mailman School of Public Health, Columbia University , New York, New York.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wen
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Deibert
authors.forename: Frank S
authors.initials: FS
authors.lastname: Siringo
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Spencer
mesh_terms: D000368:Aged; D003161:Compartment Syndromes / Q000209:etiology; D016208:Databases, Factual; D005128:Eye Diseases / Q000209:etiology; D018475:Head-Down Tilt / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D056888:Patient Positioning / Q000009:adverse effects* / Q000706:statistics & numerical data; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000209:etiology