title: Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era.
abstract: OBJECTIVE
  Given the lack of randomized trials comparing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we sought to re-examine the outcomes of these techniques using a cohort of patients treated in the postdissemination era.
  
  
  METHODS
  Overall, data from 5,915 patients with prostate cancer treated with RARP or ORP within the SEER-Medicare linked database diagnosed between October 2008 and December 2009 were abstracted. Postoperative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies, and costs of care within the first year after surgery were compared between the two surgical approaches. To decrease the effect of unmeasured confounders, instrumental variable analysis was performed. Multivariable logistic regression analyses were then performed.
  
  
  RESULTS
  Overall, 2,439 patients (41.2%) and 3,476 patients (58.8%) underwent ORP and RARP, respectively. In multivariable analyses, patients undergoing RARP had similar odds of overall complications, readmission, and additional cancer therapies compared with patients undergoing ORP. However, RARP was associated with a higher probability of experiencing 30- and 90-day genitourinary and miscellaneous medical complications (all P ≤ .02). Additionally, RARP led to a lower risk of experiencing blood transfusion and of having a pLOS (all P < .001). Finally, first-year reimbursements were greater for patients undergoing RARP compared with ORP (P < .001).
  
  
  CONCLUSIONS
  RARP and ORP have comparable rates of complications and additional cancer therapies, even in the postdissemination era. Although RARP was associated with lower risk of blood transfusions and a slightly shorter length of stay, these benefits do not translate to a decrease in expenditures.
authors.affiliation: Giorgio Gandaglia, Pierre I. Karakiewicz, and Maxine Sun, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Giorgio Gandaglia and Francesco Montorsi, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy; Jesse D. Sammon and Mani Menon, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Steven L. Chang, Toni K. Choueiri, Adam S. Kibel, Ramdev Konijeti, Paul L. Nguyen, and Quoc-Dien Trinh, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Jim C. Hu, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Simon P. Kim, Yale University, New Haven, CT; and Shyam Sukumar, University of Minnesota, Minneapolis, MN.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: Ramdev
authors.initials: R
authors.lastname: Konijeti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D018426:SEER Program