Trends in the care of radical prostatectomy in the United States from 2003 to 2006

Stephen Williams, Sandip M. Prasad, Aaron C. Weinberg, Jeremy B. Shelton, Nathanael D. Hevelone, Stuart R. Lipsitz, Jim C. Hu

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

There is an increasing trend of minimally invasive treatments for prostate cancer with increased utilization of robotic technology contributing largely to this trend. Our study found that increased utilization of MIRP corresponded with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. OBJECTIVE • To determine differences in surgical outcomes by surgical approach during a period of rapid adoption of minimally invasive surgical approaches in radical prostatectomy. PATIENTS AND METHODS • We identified 19 542 men undergoing minimally invasive (MIRP), perineal (PRP), and retropubic (RRP) radical prostatectomy from 2003 to 2006 from the MarketScan® Medstat database, a national employer-based administrative database. • We assessed for temporal trends in perioperative complications, use of postoperative cystography and anastomotic strictures by surgical approach. RESULTS • Between 2003 and 2006, MIRP use increased 33.6% vs 31.8% and 1.7% decreases in RRP and PRP, respectively. During the 4-year study, median length of stay for MIRP decreased from 2.0 to 1.0 day (P= 0.004) and overall perioperative complications decreased from 13.8 to 10.7%, (P= 0.023). • These findings were driven by reductions in genitourinary complications (3.3 to 2.5%, P= 0.049), miscellaneous surgical complications (3.6 to 2.3%, P= 0.006) and intestinal injury (1.5 to 0.1%, P= 0.009). • Median length of stay for RRP decreased from 3.2 to 2.9 days, (P <0.001), overall perioperative complications decreased from 18.1 to 14.6%, (P= 0.007), because of reductions in both wound/bleeding complications (2.0 to 1.1%, P= 0.002) and heterologous blood transfusions. • Men undergoing MIRP vs RRP were less likely to have perioperative complications (12.5 vs 17.1%, P <0.001), blood transfusions (1.5 vs 8.9%, P <0.001) and anastomotic strictures (6.3 vs 12.8%, P <0.001), and they had shorter mean lengths of stay (1.8 vs 3.1 days, P <0.001) during the study period. CONCLUSION • The increased use of MIRP corresponds with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. Further study is needed to assess the impact of tumour characteristics and surgeon volume on these perioperative outcomes as well as effects on long-term cancer control.

Original languageEnglish (US)
Pages (from-to)49-55
Number of pages7
JournalBJU International
Volume108
Issue number1
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Prostatectomy
Length of Stay
Blood Transfusion
Reoperation
Pathologic Constriction
Databases
Wounds and Injuries
Robotics
Neoplasms
Prostatic Neoplasms
Hemorrhage
Technology
Therapeutics

Keywords

  • complications
  • prostate cancer
  • radical prostatectomy minimally invasive

ASJC Scopus subject areas

  • Urology

Cite this

Williams, S., Prasad, S. M., Weinberg, A. C., Shelton, J. B., Hevelone, N. D., Lipsitz, S. R., & Hu, J. C. (2011). Trends in the care of radical prostatectomy in the United States from 2003 to 2006. BJU International, 108(1), 49-55. https://doi.org/10.1111/j.1464-410X.2010.09822.x

Trends in the care of radical prostatectomy in the United States from 2003 to 2006. / Williams, Stephen; Prasad, Sandip M.; Weinberg, Aaron C.; Shelton, Jeremy B.; Hevelone, Nathanael D.; Lipsitz, Stuart R.; Hu, Jim C.

In: BJU International, Vol. 108, No. 1, 07.2011, p. 49-55.

Research output: Contribution to journalArticle

Williams, S, Prasad, SM, Weinberg, AC, Shelton, JB, Hevelone, ND, Lipsitz, SR & Hu, JC 2011, 'Trends in the care of radical prostatectomy in the United States from 2003 to 2006', BJU International, vol. 108, no. 1, pp. 49-55. https://doi.org/10.1111/j.1464-410X.2010.09822.x
Williams, Stephen ; Prasad, Sandip M. ; Weinberg, Aaron C. ; Shelton, Jeremy B. ; Hevelone, Nathanael D. ; Lipsitz, Stuart R. ; Hu, Jim C. / Trends in the care of radical prostatectomy in the United States from 2003 to 2006. In: BJU International. 2011 ; Vol. 108, No. 1. pp. 49-55.
@article{d9f92abf1b3b4d34bde296c041e8502f,
title = "Trends in the care of radical prostatectomy in the United States from 2003 to 2006",
abstract = "There is an increasing trend of minimally invasive treatments for prostate cancer with increased utilization of robotic technology contributing largely to this trend. Our study found that increased utilization of MIRP corresponded with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. OBJECTIVE • To determine differences in surgical outcomes by surgical approach during a period of rapid adoption of minimally invasive surgical approaches in radical prostatectomy. PATIENTS AND METHODS • We identified 19 542 men undergoing minimally invasive (MIRP), perineal (PRP), and retropubic (RRP) radical prostatectomy from 2003 to 2006 from the MarketScan{\circledR} Medstat database, a national employer-based administrative database. • We assessed for temporal trends in perioperative complications, use of postoperative cystography and anastomotic strictures by surgical approach. RESULTS • Between 2003 and 2006, MIRP use increased 33.6{\%} vs 31.8{\%} and 1.7{\%} decreases in RRP and PRP, respectively. During the 4-year study, median length of stay for MIRP decreased from 2.0 to 1.0 day (P= 0.004) and overall perioperative complications decreased from 13.8 to 10.7{\%}, (P= 0.023). • These findings were driven by reductions in genitourinary complications (3.3 to 2.5{\%}, P= 0.049), miscellaneous surgical complications (3.6 to 2.3{\%}, P= 0.006) and intestinal injury (1.5 to 0.1{\%}, P= 0.009). • Median length of stay for RRP decreased from 3.2 to 2.9 days, (P <0.001), overall perioperative complications decreased from 18.1 to 14.6{\%}, (P= 0.007), because of reductions in both wound/bleeding complications (2.0 to 1.1{\%}, P= 0.002) and heterologous blood transfusions. • Men undergoing MIRP vs RRP were less likely to have perioperative complications (12.5 vs 17.1{\%}, P <0.001), blood transfusions (1.5 vs 8.9{\%}, P <0.001) and anastomotic strictures (6.3 vs 12.8{\%}, P <0.001), and they had shorter mean lengths of stay (1.8 vs 3.1 days, P <0.001) during the study period. CONCLUSION • The increased use of MIRP corresponds with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. Further study is needed to assess the impact of tumour characteristics and surgeon volume on these perioperative outcomes as well as effects on long-term cancer control.",
keywords = "complications, prostate cancer, radical prostatectomy minimally invasive",
author = "Stephen Williams and Prasad, {Sandip M.} and Weinberg, {Aaron C.} and Shelton, {Jeremy B.} and Hevelone, {Nathanael D.} and Lipsitz, {Stuart R.} and Hu, {Jim C.}",
year = "2011",
month = "7",
doi = "10.1111/j.1464-410X.2010.09822.x",
language = "English (US)",
volume = "108",
pages = "49--55",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Trends in the care of radical prostatectomy in the United States from 2003 to 2006

AU - Williams, Stephen

AU - Prasad, Sandip M.

AU - Weinberg, Aaron C.

AU - Shelton, Jeremy B.

AU - Hevelone, Nathanael D.

AU - Lipsitz, Stuart R.

AU - Hu, Jim C.

PY - 2011/7

Y1 - 2011/7

N2 - There is an increasing trend of minimally invasive treatments for prostate cancer with increased utilization of robotic technology contributing largely to this trend. Our study found that increased utilization of MIRP corresponded with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. OBJECTIVE • To determine differences in surgical outcomes by surgical approach during a period of rapid adoption of minimally invasive surgical approaches in radical prostatectomy. PATIENTS AND METHODS • We identified 19 542 men undergoing minimally invasive (MIRP), perineal (PRP), and retropubic (RRP) radical prostatectomy from 2003 to 2006 from the MarketScan® Medstat database, a national employer-based administrative database. • We assessed for temporal trends in perioperative complications, use of postoperative cystography and anastomotic strictures by surgical approach. RESULTS • Between 2003 and 2006, MIRP use increased 33.6% vs 31.8% and 1.7% decreases in RRP and PRP, respectively. During the 4-year study, median length of stay for MIRP decreased from 2.0 to 1.0 day (P= 0.004) and overall perioperative complications decreased from 13.8 to 10.7%, (P= 0.023). • These findings were driven by reductions in genitourinary complications (3.3 to 2.5%, P= 0.049), miscellaneous surgical complications (3.6 to 2.3%, P= 0.006) and intestinal injury (1.5 to 0.1%, P= 0.009). • Median length of stay for RRP decreased from 3.2 to 2.9 days, (P <0.001), overall perioperative complications decreased from 18.1 to 14.6%, (P= 0.007), because of reductions in both wound/bleeding complications (2.0 to 1.1%, P= 0.002) and heterologous blood transfusions. • Men undergoing MIRP vs RRP were less likely to have perioperative complications (12.5 vs 17.1%, P <0.001), blood transfusions (1.5 vs 8.9%, P <0.001) and anastomotic strictures (6.3 vs 12.8%, P <0.001), and they had shorter mean lengths of stay (1.8 vs 3.1 days, P <0.001) during the study period. CONCLUSION • The increased use of MIRP corresponds with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. Further study is needed to assess the impact of tumour characteristics and surgeon volume on these perioperative outcomes as well as effects on long-term cancer control.

AB - There is an increasing trend of minimally invasive treatments for prostate cancer with increased utilization of robotic technology contributing largely to this trend. Our study found that increased utilization of MIRP corresponded with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. OBJECTIVE • To determine differences in surgical outcomes by surgical approach during a period of rapid adoption of minimally invasive surgical approaches in radical prostatectomy. PATIENTS AND METHODS • We identified 19 542 men undergoing minimally invasive (MIRP), perineal (PRP), and retropubic (RRP) radical prostatectomy from 2003 to 2006 from the MarketScan® Medstat database, a national employer-based administrative database. • We assessed for temporal trends in perioperative complications, use of postoperative cystography and anastomotic strictures by surgical approach. RESULTS • Between 2003 and 2006, MIRP use increased 33.6% vs 31.8% and 1.7% decreases in RRP and PRP, respectively. During the 4-year study, median length of stay for MIRP decreased from 2.0 to 1.0 day (P= 0.004) and overall perioperative complications decreased from 13.8 to 10.7%, (P= 0.023). • These findings were driven by reductions in genitourinary complications (3.3 to 2.5%, P= 0.049), miscellaneous surgical complications (3.6 to 2.3%, P= 0.006) and intestinal injury (1.5 to 0.1%, P= 0.009). • Median length of stay for RRP decreased from 3.2 to 2.9 days, (P <0.001), overall perioperative complications decreased from 18.1 to 14.6%, (P= 0.007), because of reductions in both wound/bleeding complications (2.0 to 1.1%, P= 0.002) and heterologous blood transfusions. • Men undergoing MIRP vs RRP were less likely to have perioperative complications (12.5 vs 17.1%, P <0.001), blood transfusions (1.5 vs 8.9%, P <0.001) and anastomotic strictures (6.3 vs 12.8%, P <0.001), and they had shorter mean lengths of stay (1.8 vs 3.1 days, P <0.001) during the study period. CONCLUSION • The increased use of MIRP corresponds with a decreasing trend for complications, blood transfusions, lengths of stay and need for reoperation. Additionally, MIRP was found to have fewer associated complications compared with men undergoing open procedures. Further study is needed to assess the impact of tumour characteristics and surgeon volume on these perioperative outcomes as well as effects on long-term cancer control.

KW - complications

KW - prostate cancer

KW - radical prostatectomy minimally invasive

UR - http://www.scopus.com/inward/record.url?scp=79959318048&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959318048&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2010.09822.x

DO - 10.1111/j.1464-410X.2010.09822.x

M3 - Article

C2 - 21087390

AN - SCOPUS:79959318048

VL - 108

SP - 49

EP - 55

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 1

ER -