Login to Access Video or Poster Abstract: MP02-18
Sources of Funding: None

Introduction

Guidelines for the management of very large prostates among men with symptomatic benign prostatic enlargement suggest simple prostatectomy (SP) or enucleation for those over 80g. Minimally invasive (MI) approaches to SP have been pursued to decrease procedural morbidity, with robot-assisted SP (RASP) gaining in favor. The broad effect of the advent of robotics on the frequency of SP has not been assessed. We aimed to examine trends in the use of SP in the United States in the era of growing enucleation popularity.

Methods

Using the Premier Healthcare Database, we identified men who underwent SP (ICD-9 codes 60.3, 60.4) with a concurrent diagnosis of BPH (ICD-9: 600.x), excluding those diagnosed with prostate cancer. Using a combination of ICD-9 codes and a detailed review of the billing codes, we identified procedures as as robotic (ICD-9: 17.4x), or laparoscopic (ICD-9: 54.21). We evaluated trends across the study period (2003 to 2015) in the use of SP by surgical approach (open, laparoscopic, robotic), in addition to predictors in the use of robotic and MI (laparoscopic and robotic) SP using multivariable logistic regression models. We adjusted for potential confounders and accounted for clustering by hospitals and survey weighting to ensure nationally representative estimates.

Results

A total of 43,731 SPs (40,995 open, 1,348 laparoscopic, 1,388 robotic) were performed at 414 hospitals from 2003 to 2015. Figure 1 shows the decreasing trend in number and proportion of open SP and a gradual rise in robotic SP being performed (p<0.001). Predictors of robotic SP use include lower age (OR 0.97, p<0.01), white (vs. non-white, OR 1.88, p=0.01), larger hospital bedsize (OR 3.61, p<0.01), teaching hospital status (OR 4.54,p<0.001), Northeast region (vs. Midwest, OR 5.52, p=0.01) and higher annual surgeon volume (OR 1.28, p=0.001). Predictors of MI SP include white (OR 1.53, p=0.02), higher surgeon volume (OR 1.15, p=0.08) and lower hospital volume (OR 0.93, p<0.01).

Conclusions

Though RASP is increasing as a percentage of SPs performed, it's growth in use has not lead to an increase in SP frequency, likely owing to its morbidity profile and the growing popularity of enucleation. The increasing use of MI, particularly robotic, SP is secondary to a variety of patient, hospital and surgical characteristics.

Funding

None