Abstract
Objective
In this study, we document trends in radical prostatectomy (RP) employment in Germany during the period 2005–2012 and compare the morbidity of open (ORP), laparoscopic and robotic-assisted RP based on nationwide administrative data of Allgemeine Ortskrankenkassen (AOK) German local healthcare funds.
Materials and methods
Administrative claims data of all AOK patients subjected to RP during 2005–2012 (57,156 cases) were used to evaluate the employment of minimally invasive RP (MIRP) procedures, pelvic lymph node dissection (PLND) and nerve-sparing approaches during this period. In addition, data from the most recent three-year period of our dataset (2010–2012) were used to compare the morbidity among the different surgical approaches. Study end points comprised 30-day mortality, 30-day transfusion, 1-year reintervention and 30-day adverse events, as well as 1-year overall complications.
Results
A 20 % reduction in RP utilization from 2007 to 2012 was documented. ORP remained the predominant RP approach in Germany. MIRP approaches carried a lower risk of 30-day transfusions, 1-year reinterventions and 1-year overall complications than ORP when adjusting for confounding factors. PLND was associated with an increased risk of complications, while age in the highest quintile and the presence of comorbidities were independent risk factors for morbidity and mortality. Lack of pathological data was the main limitation of the study.
Conclusions
RP utilization in Germany is dropping, but the use of MIRP has risen steadily during the years 2005–2012, which is expected to have a positive impact on the morbidity of the operation.
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Author contribution
Stolzenburg was involved in protocol/project development/data analysis/study supervision. Kyriazis contributed to data analysis/manuscript writing/editing. Fahlenbrach, Gilfrich, Günster, Jeschke, Popken, Weißbach, von Zastrow, Hanna Leicht were involved in data collection/data analysis/manuscript editing.
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Stolzenburg, J.U., Kyriazis, I., Fahlenbrach, C. et al. National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany. World J Urol 34, 1515–1520 (2016). https://doi.org/10.1007/s00345-016-1813-7
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DOI: https://doi.org/10.1007/s00345-016-1813-7