title: Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013.
abstract: In 2012, Japanese national insurance started covering robot-assisted surgery. We carried out a population-based comparison between robot-assisted and three other types of radical prostatectomy to evaluate the safety of robot-assisted prostatectomy during its initial year. We abstracted data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot-assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012-March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one-to-one propensity-score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot-assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot-assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, -5.1%, -1.8% [not significant], -10.8%) and shorter postoperative length of stay (-9.1%, +0.9% [not significant], -18.5%, respectively). However, robot-assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P < 0.05). Introduction of robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot-assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Department of Urology, The University of Tokyo, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.forename: Yu
authors.initials: Y
authors.lastname: Changhong
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D017048:Health Care Costs; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012307:Risk Factors; D065287:Robotic Surgical Procedures
keywords: Laparoscopy; minimally invasive; prostatic neoplasm; robot technology; surgical procedures