The impact of radical prostatectomy operative time on outcomes and costs
Journal
Urology
Journal Volume
83
Journal Issue
6
Pages
1265-1272
Date Issued
2014
Author(s)
Abstract
Objective To examine the impact of radical prostatectomy (RP) operative time on outcomes and cost, we performed a population-based assessment of operative time as a predictor of outcomes. Although operative time has been used as a metric to evaluate RP surgeon learning curves, the effect of RP operative times on outcomes remains understudied. Materials and Methods We used US Surveillance, Epidemiology, and End Results-Medicare linked data to identify 7534 men aged ?66 years diagnosed with prostate cancer during 2003-2007 who underwent RP for localized prostate cancer through 2009. We categorized RP operative time into quartiles (short, intermediate, long, and very long) and used propensity score analyses to assess its impact on perioperative complications, mortality, length of hospitalization, readmissions, emergency room visits, and costs. Results Quartiles ranged from 0 to 172 minutes for short, 173 to 214 minutes for intermediate, 215 to 268 minutes for long, and ?269 minutes for very long RP operative times. After propensity score adjustment, longer operative time was associated with more surgery-related complications (short, 12.0%; intermediate, 12.3%; long, 14.4%; and very long, 22.8%; P <.001), longer median (interquartile range) length of stay in days (short, 2 [2-3]; intermediate, 2 [2-3]; long, 2 [1-3]; and very long, 2 [1-3]; P <.001), and higher median costs (short, $10,647; intermediate, $10,957; long, $11,405; and very long, $11,966; P <.001). Conclusion Longer RP operative time is associated with more complications, longer lengths of hospital stay, and higher costs. Increasing operative efficiency may reduce complications, length of stay, and health-care costs. ? 2014 Elsevier Inc. All Rights Reserved.
SDGs
Other Subjects
aged; article; emergency ward; health care cost; hospital readmission; human; length of stay; major clinical study; male; operation duration; peroperative complication; priority journal; propensity score; prostatectomy; surgical mortality; treatment outcome; Aged; Aged, 80 and over; Benchmarking; Cohort Studies; Health Care Costs; Humans; Length of Stay; Male; Operative Time; Patient Readmission; Postoperative Complications; Prognosis; Prostatectomy; Prostatic Neoplasms; Registries; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Rate; Treatment Outcome
Publisher
Elsevier Inc.
Type
journal article