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

  • 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
Original Article

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.

Keywords

Robotic-assisted Hospital charges National inpatient sample Prostatectomy Regions 

Notes

Authors’ contribution

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

345_2018_2525_MOESM1_ESM.docx (138 kb)
Supplementary material 1 (DOCX 138 kb)
345_2018_2525_MOESM2_ESM.docx (103 kb)
Supplementary material 2 (DOCX 102 kb)
345_2018_2525_MOESM3_ESM.pdf (729 kb)
Supplementary material 3 (PDF 728 kb)
345_2018_2525_MOESM4_ESM.docx (61 kb)
Supplementary material 4 (DOCX 61 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Felix Preisser
    • 1
    • 2
    • 3
    • 4
  • Sebastiano Nazzani
    • 1
    • 2
    • 5
  • Elio Mazzone
    • 1
    • 2
    • 6
    • 7
  • Sophie Knipper
    • 3
    • 4
  • Marco Bandini
    • 1
    • 2
    • 6
    • 7
  • Zhe Tian
    • 1
  • Alexander Haese
    • 3
  • Fred Saad
    • 1
    • 2
  • Kevin C. Zorn
    • 1
    • 2
  • Francesco Montorsi
    • 6
    • 7
  • Shahrokh F. Shariat
    • 8
  • Markus Graefen
    • 3
  • Derya Tilki
    • 3
    • 4
  • Pierre I. Karakiewicz
    • 1
    • 2
  1. 1.Cancer Prognostics and Health Outcomes UnitUniversity of Montreal Health CenterMontrealCanada
  2. 2.Centre de recherche du Centre Hospitalier de l’Université de Montréal (CR-CHUM) and Institut du Cancer de MontréalMontrealCanada
  3. 3.Martini-Klinik Prostate Cancer CenterUniversity Hospital Hamburg-EppendorfHamburgGermany
  4. 4.Department of UrologyUniversity Hospital Hamburg-EppendorfHamburgGermany
  5. 5.Academic Department of Urology, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
  6. 6.Division of Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly
  7. 7.Vita-Salute San Raffaele UniversityMilanItaly
  8. 8.Department of UrologyMedical University of ViennaViennaAustria

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