title: The impact of robotic surgery on the surgical management of prostate cancer in the USA.
abstract: OBJECTIVE
  To describe the surgeon characteristics associated with robot-assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost.
  
  
  METHODS
  A retrospective cohort study with a weighted sample size of 489,369 men who underwent non-RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures.
  
  
  RESULTS
  From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High-volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7-3.4), intermediate- (200-399 beds; OR 5.96, 95% CI 1.3-26.5) and large-sized hospitals (≥ 400 beds; OR 6.1, 95% CI 1.4-25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7-6.4). RARP adoption was generally associated with increased RP volume, greatest for high-volume surgeons and least for low-volume surgeons (<5 RPs annually). The annual number of surgeons performing RP decreased from about 10,000 to 8200, with the proportion of cases performed by high-volume surgeons increasing from 10% to 45%. RARP was more costly, disproportionally contributing to the 40% increase in annual prostate cancer surgery expenditures. RARP costs generally decreased plateauing at slightly over $10,000, while non-RARP costs increased to nearly $9000 by the end of the study.
  
  
  CONCLUSIONS
  There was widespread RARP adoption in the USA between 2003 and 2010, particularly among high-volume surgeons. The diffusion of RARP was associated with a centralisation of care and an increased economic burden for prostate cancer surgery.
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Steven L
authors: SL
authors: Chang
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Adam S
authors: AS
authors: Kibel
authors: Department of Urology, Stanford University Medical Centre, Stanford, CA, USA.
authors: James D
authors: JD
authors: Brooks
authors: Department of Urology, Stanford University Medical Centre, Stanford, CA, USA.
authors: Benjamin I
authors: BI
authors: Chung
mesh_terms: D000328:Adult; D000368:Aged; D004059:Diffusion of Innovation; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D066231:Surgeons / Q000706:statistics & numerical data; D014481:United States
keywords: diffusion of innovation; health expenditures; physician's practice patterns; prostatic neoplasms; robotics