title: da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs.
abstract: OBJECTIVE
  To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany.
  
  
  METHODS
  Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study.
  
  
  RESULTS
  Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676).
  
  
  CONCLUSIONS
  The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.
authors.affiliation: Saarland University Medical Center, Department of Urology and Pediatric Urology, Homburg/Saar, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Niklas
authors.forename: Matthias
authors.initials: M
authors.lastname: Saar
authors.forename: Britta
authors.initials: B
authors.lastname: Berg
authors.forename: Katrin
authors.initials: K
authors.lastname: Steiner
authors.forename: Martin
authors.initials: M
authors.lastname: Janssen
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
authors.forename: Carsten-Henning
authors.initials: CH
authors.lastname: Ohlmann
mesh_terms: D000368:Aged; D002404:Catheterization; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059035:Perioperative Period; D011183:Postoperative Complications; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome