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01-07-2019 | Original Article

Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States

Authors: Felix Preisser, Sebastiano Nazzani, Elio Mazzone, Sophie Knipper, Marco Bandini, Zhe Tian, Alexander Haese, Fred Saad, Kevin C. Zorn, Francesco Montorsi, Shahrokh F. Shariat, Markus Graefen, Derya Tilki, Pierre I. Karakiewicz

Published in: World Journal of Urology | Issue 7/2019

Abstract

Background

Robotically assisted radical prostatectomy (RARP) has become the most frequently used surgical approach for patients treated with radical prostatectomy (RP) for localized prostate cancer (PCa). Previous studies reported higher total hospital charges (THCs) for RARP than open RP (ORP). We hypothesized that based on increasing RARP surgical expertise, differences in THCs between RARP and ORP should have decreased or even disappeared in the United States in most contemporary years.

Patients and methods

Within the National Inpatient Sample database (2008–2015), we identified patients who underwent RARP or ORP. Multivariable linear regression models with adjustment for clustering were used to test for differences in THCs. Subgroup analyses focused on geographical regions, defined as West, Midwest, South and Northeast.

Results

Of 83,693 RP patients, 51,363 (61.4%) underwent RARP. RARP rates increased from 13.1 to 81.5% (p = 0.04). Overall, median THCs were $11,898 vs. $10,162 (p < 0.001) for RARP vs. ORP, respectively. After adjustment for complications, length of stay and clustering, RARP was associated with higher THCs ($3124 more for each RARP, p < 0.001). Additional charges for RARP did not change over time (p = 0.3). However, additional charges for RARP were highest in the West ($4610, p < 0.001), followed by the Midwest ($3278, p < 0.001), the South ($2906, p < 0.001) and the Northeast ($2216, p < 0.001).

Conclusion

RARP rates have increased exponentially from 13.1 to over 80%. Similar rates were identified across all four geographical regions. RARP THCs exceeded those of ORP. Finally, important regional differences in RARP THCs were identified and persisted even after most detailed adjustment for population differences.

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Title: Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States
Authors: Felix Preisser
Sebastiano Nazzani
Elio Mazzone
Sophie Knipper
Marco Bandini
Zhe Tian
Alexander Haese
Fred Saad
Kevin C. Zorn
Francesco Montorsi
Shahrokh F. Shariat
Markus Graefen
Derya Tilki
Pierre I. Karakiewicz
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 7/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2525-y

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Springer Medicine

Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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