title: Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: results from a privately insured patient population.
abstract: BACKGROUND
  With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer.
  
  
  METHODS
  Using a large private insurance database, we identified 17,610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches.
  
  
  RESULTS
  Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P<0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P<0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P<0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P=0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US $19,292 vs. US $17,347; P<0.001).
  
  
  CONCLUSIONS
  Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.
authors.affiliation: 1] University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH, USA [2] Center for Reducing Racial Disparities, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: 1] Yale University, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA [2] Department of Internal Medicine, Yale University, New Haven, CT, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Han
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: H
authors.initials: H
authors.lastname: Van Houten
authors.affiliation: Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Department of Urology, UT Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Svatek
authors.affiliation: Mayo Clinic, Department of Urology, Rochester, MN, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Thompson
authors.affiliation: Mayo Clinic, Department of Urology, Rochester, MN, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, Dana Farber Cancer Institute, Division of Urologic Surgery, Boston, MA, USA.
authors.forename: Q-D
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kutikov
authors.affiliation: 1] Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA [2] Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, MN, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Shah
mesh_terms: D000328:Adult; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011468:Prostatectomy / Q000191:economics*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome