Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
BJU Int. 2014 May;113(5b):E112-8. doi: 10.1111/bju.12451. Epub 2014 Jan 15.
To determine factors that influence radical prostatectomy (RP) operative times. Operative time assessment is inherent to defining surgeon learning curves and evaluating quality of care.
SUBJECTS/PATIENTS AND METHODS: Population-based observational cohort study using USA Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data of men diagnosed with prostate cancer during 2003-2007 who underwent robot-assisted radical prostatectomy (RARP, 3458 men) and retropubic RP (RRP, 6993) through to 2009. We obtained median operative time using anaesthesia administrative data for RP and used median regression to assess the contribution of patient, surgeon, and hospital factors to operative times.
The median RARP operative time decreased from 315 to 247 min from 2003 to 2008-2009 (P < 0.001), while the median RRP operative time remained similar (195 vs 197 min, P = 0.90). In adjusted analysis, RARP vs RRP (parameter estimate [PE] 70.9; 95% confidence interval [CI] 58, 84; P < 0.001) and obesity (PE 15; 95% CI 7, 23; P < 0.001) were associated with longer operative times while higher surgeon volumes were associated with shorter operative times (P < 0.001). RPs performed by surgeons employed by group (parameter estimate [PE] -22.76; 95% CI -38, -7.49; P = 0.004) and non-government (PE -35.59; 95% CI -68.15, -3.03; P = 0.032) vs government facilities and non-profit vs government hospital ownership (PE -21.85; 95% CI -32.28, -11.42; P < 0.001) were associated with shorter operative times.
During our study period, RARP operative times decreased by 68 min while RRP operative times remained stagnant. Higher surgeon volume was associated with shorter operative times, and selective referral or improved efficiency to the level of high-volume surgeons would net almost $15 million (USA dollars) in annual savings.
确定影响根治性前列腺切除术（RP）手术时间的因素。手术时间评估是确定外科医生学习曲线和评估护理质量的固有内容。
受试者/患者和方法：这是一项基于人群的观察性队列研究，使用美国监测、流行病学和最终结果（SEER）-医疗保险链接数据，纳入 2003 年至 2007 年间诊断为前列腺癌的男性患者，这些患者在 2009 年前接受了机器人辅助根治性前列腺切除术（RARP，3458 例）和经耻骨后前列腺切除术（RRP，6993 例）。我们从麻醉管理数据中获得了 RP 的中位手术时间，并使用中位数回归评估了患者、外科医生和医院因素对手术时间的贡献。
从 2003 年至 2008-2009 年，RARP 的中位手术时间从 315 分钟降至 247 分钟（P<0.001），而 RRP 的中位手术时间保持相似（195 分钟 vs 197 分钟，P=0.90）。在调整分析中，RARP 与 RRP（参数估计值 [PE] 70.9；95%置信区间 [CI] 58，84；P<0.001）和肥胖症（PE 15；95%CI 7，23；P<0.001）与手术时间延长相关，而较高的外科医生手术量与手术时间缩短相关（P<0.001）。由受雇于集团的外科医生（参数估计值 [PE] -22.76；95%CI -38，-7.49；P=0.004）和非政府（PE -35.59；95%CI -68.15，-3.03；P=0.032）进行的 RP 与政府设施和非营利与政府医院所有权（PE -21.85；95%CI -32.28，-11.42；P<0.001）与手术时间缩短相关。
在我们的研究期间，RARP 手术时间减少了 68 分钟，而 RRP 手术时间保持不变。较高的外科医生手术量与手术时间缩短相关，选择性转诊或向高手术量外科医生的效率提高将带来近 1500 万美元（美元）的年度节省。
