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

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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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Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Felix Preisser, Sebastiano Nazzani, Elio Mazzone, Marco Bandini, Zhe Tian, Fred Saad, Kevin C. Zorn & Pierre I. Karakiewicz

  2. Centre de recherche du Centre Hospitalier de l’Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montreal, QC, Canada

    Felix Preisser, Sebastiano Nazzani, Elio Mazzone, Marco Bandini, Fred Saad, Kevin C. Zorn & Pierre I. Karakiewicz

  3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Felix Preisser, Sophie Knipper, Alexander Haese, Markus Graefen & Derya Tilki

  4. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Felix Preisser, Sophie Knipper & Derya Tilki

  5. Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy

    Sebastiano Nazzani

  6. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Elio Mazzone, Marco Bandini & Francesco Montorsi

  7. Vita-Salute San Raffaele University, Milan, Italy

    Elio Mazzone, Marco Bandini & Francesco Montorsi

  8. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

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  1. Felix Preisser
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  2. Sebastiano Nazzani
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Contributions

FP protocol/project development, data analysis, manuscript writing/editing. SN data analysis. EM Manuscript writing/editing. SK data collection or management. MB Data analysis. ZT data collection or management. AH protocol/project development, manuscript writing/editing. FS manuscript writing/editing. KCZ Data analysis. FM manuscript writing/editing. SFS manuscript writing/editing. MG manuscript writing/editing. DT protocol/project development, manuscript writing/editing. PIK protocol/project development, data analysis, manuscript writing/editing.

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Correspondence to Felix Preisser.

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Preisser, F., Nazzani, S., Mazzone, E. et al. Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States. World J Urol 37, 1305–1313 (2019). https://doi.org/10.1007/s00345-018-2525-y

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