Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Urology. 2014 Jun;83(6):1265-71. doi: 10.1016/j.urology.2014.01.047. Epub 2014 Apr 24.
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.
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.
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).
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.
为了研究根治性前列腺切除术（RP）手术时间对结果和成本的影响，我们对手术时间作为结果预测指标进行了基于人群的评估。尽管手术时间已被用作评估 RP 外科医生学习曲线的指标，但 RP 手术时间对结果的影响仍研究不足。
我们使用美国监测、流行病学和最终结果-医疗保险链接数据，确定了 2003 年至 2007 年间年龄≥66 岁、被诊断为局限性前列腺癌并在 2009 年前接受过 RP 治疗的 7534 名男性。我们将 RP 手术时间分为四组（短、中、长和非常长），并使用倾向评分分析评估其对围手术期并发症、死亡率、住院时间、再入院、急诊就诊和成本的影响。
短时间组的四分位范围为 0 至 172 分钟，中间时间组为 173 至 214 分钟，长时间组为 215 至 268 分钟，非常长时间组≥269 分钟。在倾向评分调整后，较长的手术时间与更多的手术相关并发症相关（短时间组为 12.0%；中间时间组为 12.3%；长时间组为 14.4%；非常长时间组为 22.8%；P<.001），中位（四分位间距）住院天数更长（短时间组为 2 [2-3]；中间时间组为 2 [2-3]；长时间组为 2 [1-3]；非常长时间组为 2 [1-3]；P<.001），中位费用更高（短时间组为 10647 美元；中间时间组为 10957 美元；长时间组为 11405 美元；非常长时间组为 11966 美元；P<.001）。
较长的 RP 手术时间与更多的并发症、更长的住院时间和更高的成本相关。提高手术效率可能会降低并发症、住院时间和医疗保健成本。
