title: National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany.
abstract: OBJECTIVE
  In this study, we document trends in radical prostatectomy (RP) employment in Germany during the period 2005-2012 and compare the morbidity of open (ORP), laparoscopic and robotic-assisted RP based on nationwide administrative data of Allgemeine Ortskrankenkassen (AOK) German local healthcare funds.
  
  
  METHODS
  Administrative claims data of all AOK patients subjected to RP during 2005-2012 (57,156 cases) were used to evaluate the employment of minimally invasive RP (MIRP) procedures, pelvic lymph node dissection (PLND) and nerve-sparing approaches during this period. In addition, data from the most recent three-year period of our dataset (2010-2012) were used to compare the morbidity among the different surgical approaches. Study end points comprised 30-day mortality, 30-day transfusion, 1-year reintervention and 30-day adverse events, as well as 1-year overall complications.
  
  
  RESULTS
  A 20 % reduction in RP utilization from 2007 to 2012 was documented. ORP remained the predominant RP approach in Germany. MIRP approaches carried a lower risk of 30-day transfusions, 1-year reinterventions and 1-year overall complications than ORP when adjusting for confounding factors. PLND was associated with an increased risk of complications, while age in the highest quintile and the presence of comorbidities were independent risk factors for morbidity and mortality. Lack of pathological data was the main limitation of the study.
  
  
  CONCLUSIONS
  RP utilization in Germany is dropping, but the use of MIRP has risen steadily during the years 2005-2012, which is expected to have a positive impact on the morbidity of the operation.
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jens Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany. jkyriazis@gmail.com.
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.affiliation: Federal Association of the Local Health Care Funds (AOK), Berlin, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Fahlenbrach
authors.affiliation: Department of Urology, Klinikum St. Elisabeth Straubing, Straubing, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.affiliation: Research Institute of the Local Health Care Funds (AOK), Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Günster
authors.affiliation: Research Institute of the Local Health Care Funds (AOK), Berlin, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Jeschke
authors.affiliation: Department of Urology, Klinikum Ernst von Bergmann, Potsdam, Germany.
authors.forename: Gralf
authors.initials: G
authors.lastname: Popken
authors.affiliation: Stiftung Männergesundheit, Berlin, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Weißbach
authors.affiliation: Medical Review Board of the Social Health Insurance Funds, Hannover, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: von Zastrow
authors.affiliation: Research Institute of the Local Health Care Funds (AOK), Berlin, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Leicht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000379:methods*; D015996:Survival Rate / Q000639:trends
keywords: Complications; Germany; Laparoscopic radical prostatectomy; Morbidity; Open radical prostatectomy; Radical prostatectomy; Robotic assisted