Department of Urology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
J Endourol. 2014 Apr;28(4):430-6. doi: 10.1089/end.2013.0656. Epub 2014 Jan 4.
Many American hospitals will soon face readmission penalties deducted from Medicare reimbursements, which will place further scrutiny on techniques that may offer reduced postoperative morbidity. We aimed to perform the first multi-institutional study using the National Surgical Quality Improvement Program (NSQIP) database, to compare predictors of readmission within cohorts of open radical retropubic prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALRP) in a contemporary nationwide series of radical prostatectomy.
All patients who underwent radical prostatectomy in 2011 were identified in the NSQIP database using procedural codes. As no patients in the analysis underwent LRP, patients were grouped as RRP or RALRP for analysis. Perioperative variables were analyzed using chi-squared and Student's t-tests as appropriate. Multiple logistic regression was used to identify readmission risk factors.
Of 5471 patient cases analyzed, 4374 (79.9%) and 1097 (20.1%) underwent RALRP and RRP, respectively. RRP and RALRP cohorts experienced different readmission rates (5.47% vs 3.48%, respectively; p=0.002). In addition, RRP experienced a higher rate of overall complications than RALRP (23.25% vs 5.62%, respectively; p<0.001), but not higher rates of reoperation (1.09% vs 0.96%, respectively; p=0.689). Overall predictors of readmission included operative time, dyspnea, and RRP or RALRP procedure type. Current smoking and patient age were predictive of readmission for RRP only, while dyspnea was predictive of readmission following RALRP only.
This is the first multi-institutional retrospective study that examines readmission rates and procedural intracohort predictors of readmission for RRP in the contemporary United States. We report a significant difference in postoperative complication and readmission rates in RRP compared with RALRP. Further prospective analysis is warranted.
许多美国医院很快将面临从医疗保险报销中扣除的再入院罚款，这将对可能降低术后发病率的技术进行进一步审查。我们旨在使用国家外科质量改进计划（NSQIP）数据库进行第一项多机构研究，以比较在当代全国范围内根治性前列腺切除术队列中，开放性根治性耻骨后前列腺切除术（RRP）和机器人辅助腹腔镜根治性前列腺切除术（RALRP）中再入院的预测因素。
使用手术代码在 NSQIP 数据库中确定 2011 年接受根治性前列腺切除术的所有患者。由于分析中没有患者接受 LRP，因此将患者分为 RRP 或 RALRP 进行分析。使用卡方检验和学生 t 检验分析围手术期变量。使用多变量逻辑回归确定再入院的危险因素。
在分析的 5471 例患者中，分别有 4374 例（79.9%）和 1097 例（20.1%）接受了 RALRP 和 RRP。RRP 和 RALRP 队列的再入院率不同（分别为 5.47%和 3.48%；p=0.002）。此外，RRP 的总体并发症发生率高于 RALRP（分别为 23.25%和 5.62%；p<0.001），但再手术率没有更高（分别为 1.09%和 0.96%；p=0.689）。再入院的总体预测因素包括手术时间、呼吸困难以及 RRP 或 RALRP 手术类型。当前吸烟和患者年龄是 RRP 再入院的预测因素，而呼吸困难是 RALRP 再入院的预测因素。
这是第一项多机构回顾性研究，检查了美国当代 RRP 的术后并发症和再入院率的队列内预测因素。我们报告了 RRP 与 RALRP 相比，术后并发症和再入院率存在显著差异。需要进一步进行前瞻性分析。
