title: Robot-assisted versus open radical prostatectomy utilization in hospitals offering robotics.
abstract: BACKGROUND
  Prostate cancer is an extremely prevalent cause of morbidity and mortality among American men. Several different treatments exist, but differences in utilization between these treatments are not well understood.
  
  
  METHODS
  We performed an observational study using administrative datasets linked to hospital survey data, which included non-metastatic prostate cancer patients receiving robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) in California, Florida, or New York from 2009-2011. We developed two hierarchical regression models with fixed effect accounting for hospital clustering and physician clustering to determine factors associated with utilization of RARP versus ORP at hospitals offering robotic surgery.
  
  
  RESULTS
  A total of 36,694 patients were identified, with 77.13% receiving RARP and 22.87% receiving ORP. African American patients had lower RARP rates than White patients (OR = 0.80, p < 0.001). Patients using Medicare (OR = 0.91, p = 0.028), Medicaid (OR = 0.68, p < 0.001), or self-pay (OR = 0.72, p = 0.046) had lower RARP rates than patients using private insurance. Patients in Florida had lower RARP rates than patients in California (OR = 0.48, p = 0.010). Patients treated at teaching hospitals had lower RARP rates than patients treated at non-teaching hospitals (OR = 0.50, p = 0.006). The average cost of RARP was $13,614.83, and the average cost of ORP was $12,167.44 (p < 0.001).
  
  
  CONCLUSIONS
  This population based study suggests that both patient and hospital characteristics are associated with utilization of RARP versus ORP in hospitals where robotic surgery is offered.
authors.affiliation: Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Swati
authors.initials: S
authors.lastname: Yanamadala
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.forename: Tina M
authors.initials: TM
authors.lastname: Hernandez-Boussard
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002140:California; D016208:Databases, Factual; D005382:Financing, Personal / Q000706:statistics & numerical data; D005431:Florida; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009518:New York; D011468:Prostatectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D044465:White People / Q000706:statistics & numerical data