Impact of Increasing Prevalence of Minimally Invasive Prostatectomy on Open Prostatectomy Observed in the National Inpatient Sample and National Surgical Quality Improvement Program
Impact of Increasing Prevalence of Minimally Invasive Prostatectomy on Open Prostatectomy Observed in the National Inpatient Sample and National Surgical Quality Improvement Program
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DOI：
10.1089/end.2012.0315
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发表时间：
2013-01-01
影响因子：
2.7
通讯作者：
Zhao, Lee C.
中科院分区：
文献类型：
--
作者：
Hofer, Matthias D.;Meeks, Joshua J.;Zhao, Lee C.
背景和目的：腹腔镜手术，尤其是机器人辅助的微创前列腺切除术（MIP）在过去十年中越来越受欢迎。我们分析了 MIP 患病率的增加如何影响 MIP 和开放根治性前列腺切除术 (RRP) 的结果。方法：在全国住院患者样本中，报告了 2002 年至 2008 年间接受 MIP 的 23,473 名患者和接受 RRP 的 118,266 名患者。我们分析了住院时间 (LOS)、住院费用 (THC)、并发症发生率 (CR) 和社会经济特征。我们使用美国外科医生学会国家手术质量改进计划 (NSQIP) 来确定并发症发生率（RRP n = 666，MIP n = 2205）。结果：MIP 的比例从 2002 年的 1.4% 增加到 2008 年的 29.5%。MIP 的平均 LOS 减少（2002 年为 2.4 天，2008 年为 1.6 天），建议零售价（2002 年为 3.1 天，2008 年为 2.1 天）。 MIP 的平均 THC 有所下降（2002 年为 46,000 美元，2008 年为 34,000 美元），而 RRP 的平均 THC 有所增加（2002 年为 18,000 美元，2008 年为 32,000 美元）。 2005 年之后，MIP 的总体 CR 低于 RRP。高容量中心报告这两种手术的 CR 均较低。 MIP 与较少的输血和伤口并发症有关。居住在年平均家庭收入最高四分之一的邮政编码地区的男性比 RRP 更有可能接受 MIP（P < 0.001）。虽然接受 MIP 的白人患者较多，接受 RRP 的黑人或西班牙裔患者较多，但没有统计学上的显着差异。结论：MIP 使用的增加导致所有患者的住院时间减少，RRP 费用增加，MIP 和 RRP 的 CR 均下降。近年来，MIP 的并发症较少。 RRP 的费用随着时间的推移而增加，接近 MIP 的费用，并且社会经济地位提高的患者更有可能接受 MIP。
Background and Purpose: Laparoscopic and especially robot-assisted minimally invasive prostatectomy (MIP) has increased in popularity over the past decade. We analyzed how the increasing prevalence of MIP has affected the outcomes of MIP and open radical prostatectomy (RRP).Methods: In the Nationwide Inpatient Sample, 23,473 patients undergoing MIP and 118,266 undergoing RRP between 2002 and 2008 are reported. We analyzed length of stay (LOS), hospital charges (THC), complication rates (CR), and socioeconomic characteristics. We used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to identify complication rates (RRP n = 666, and MIP n = 2205).Results: The proportion of MIP increased from 1.4% in 2002 to 29.5% in 2008. Mean LOS decreased for MIP (2.4 days in 2002, 1.6 days in 2008) and RRP (3.1 days in 2002, 2.1 days in 2008). Mean THC for MIP decreased ($46k in 2002, $34k in 2008) and increased for RRP ($18k in 2002, $32k in 2008). After 2005, overall CRs of MIP were lower than for RRP. High-volume centers reported lower CRs for both procedures. MIP was associated with fewer transfusions and wound complications. Men living in ZIP codes with the top quartile of yearly mean household income were more likely to undergo MIP than RRP (P < 0.001). Although there were more white patients receiving MIP and black or Hispanic patients more frequently underwent RRP, there was no statistically significant difference.Conclusions: Increasing use of MIP led to decreased hospital stay for all patients, increase charges for RRP, and decreased CRs for both MIP and RRP. In recent years, MIP was associated with fewer complications. Charges for RRP have increased over time to approach those for MIP, and patients with increased socio-economic status were more likely to undergo MIP.