title: Robot-assisted Versus Open Radical Prostatectomy: A Contemporary Analysis of an All-payer Discharge Database.
abstract: More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy.
  
  
  
  To compare outcomes and costs between RARP and open RP (ORP).
  
  
  
  A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database.
  
  
  
  RARP was ascertained through a review of the hospital charge description master for robotic supplies.
  
  
  
  Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates.
  
  
  
  RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study.
  
  
  
  Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP.
  
  
  
  In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Leow
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ye
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Cole
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Preston
authors.affiliation: Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, UK.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: trinh.qd@gmail.com.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D017721:Hospital Costs; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Comparative effectiveness research; Complications; Costs; Prostate cancer; Radical prostatectomy; Robot-assisted