The impact of radical prostatectomy operative time on outcomes and costs.
OBJECTIVE
To examine the impact of radical prostatectomy (RP) operative time on outcomes and cost, we performed a population-based assessment of operative time as a predictor of outcomes. Although operative time has been used as a metric to evaluate RP surgeon learning curves, the effect of RP operative times on outcomes remains understudied.


METHODS
We used US Surveillance, Epidemiology, and End Results-Medicare linked data to identify 7534 men aged≥66 years diagnosed with prostate cancer during 2003-2007 who underwent RP for localized prostate cancer through 2009. We categorized RP operative time into quartiles (short, intermediate, long, and very long) and used propensity score analyses to assess its impact on perioperative complications, mortality, length of hospitalization, readmissions, emergency room visits, and costs.


RESULTS
Quartiles ranged from 0 to 172 minutes for short, 173 to 214 minutes for intermediate, 215 to 268 minutes for long, and ≥269 minutes for very long RP operative times. After propensity score adjustment, longer operative time was associated with more surgery-related complications (short, 12.0%; intermediate, 12.3%; long, 14.4%; and very long, 22.8%; P<.001), longer median (interquartile range) length of stay in days (short, 2 [2-3]; intermediate, 2 [2-3]; long, 2 [1-3]; and very long, 2 [1-3]; P<.001), and higher median costs (short, $10,647; intermediate, $10,957; long, $11,405; and very long, $11,966; P<.001).


CONCLUSIONS
Longer RP operative time is associated with more complications, longer lengths of hospital stay, and higher costs. Increasing operative efficiency may reduce complications, length of stay, and health-care costs.
Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Kuo-How
KH
Huang
Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Alan L
AL
Kaplan
Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Stacey C
SC
Carter
Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Stuart R
SR
Lipsitz
Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. Electronic address: jchu@mednet.ucla.edu.
Jim C
JC
Hu
D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D015331:Cohort Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D061646:Operative Time; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000503:physiopathology; D011379:Prognosis; D011468:Prostatectomy / Q000191:economics* / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome