RASP predictors: Hospital size, region
On multivariable logistic regression, predictors of performing RASP were larger hospital size, hospital region, higher annual surgeon volume, and the period during which the procedure was performed.
Among the findings:
- The odds ratio (OR) for robotic simple prostatectomy at hospitals with ≥500 beds was 3.43 (p=.010) compared with hospitals with <300 beds. RASP was also more likely to be performed at hospitals with 300 to 499 beds compared with <300 beds (OR: 2.72, p=.036).
- RASP was more likely to be performed at hospitals in the Northeast (OR: 5.55, p=.007) and South (OR: 4.47, p=.013) than in the Midwest.
- The OR for RASP with higher annual surgical volume was 1.20 (p=.047).
- RASP was almost seven times as likely (OR 6.98, p<.001) when simple prostatectomy was performed in 2011 to 2015 compared with 2003 to 2006.
- The OR for RASP in a teaching hospital was 4.44 (p<.0001) compared with a non-teaching hospital.
In addition to examining trends in the use of RASP, 90-day rates of mortality, complications, and readmissions; receipt of blood transfusions; postoperative use of vasopressors, and postoperative intensive care unit stay were also examined.
“The outcomes were pretty equivalent across the procedures, but in terms of postoperative ICU stay, the proportion of patients who underwent RASP was only 2.7% compared with 5% for the open group (p=.20). In addition, the receipt of blood transfusion was much less in the robotic group (14.6% vs. 24.4%, p=.01). This underscores what we know that open simple prostatectomy is traditionally a bloody procedure and such morbidity can potentially be overcome by the robotic platform,” Dr. Leow said.
Median costs were about 15% higher in the groups undergoing laparoscopic simple prostatectomy or RASP compared with open simple prostatectomy.
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