Radical Prostatectomy Trends in the United States: 1998 to 2011.

OBJECTIVE

To determine the incidence and distribution of radical prostatectomy (RP) in the United States over time.

PATIENTS AND METHODS

We conducted a serial cross-sectional analysis of time trends using the Nationwide Inpatient Sample of adult men older than 45 years who underwent RP between January 1, 1998, and December 31, 2011.

RESULTS

Weighted estimates revealed that 962,917 men underwent RP during the study period. The annual rate of RP remained relatively stable, from 1425 RPs per million in the period 1998 to 1999 to 1330 RPs per million in the period 2010 to 2011 (7% decrease; P=.90). The annual rate of open RP decreased from 1424 per million to 435 per million (P<.001), whereas the annual rate of minimally invasive RP increased from less than 1 per million to 895 per million (P<.001). Since 2006, hospitals providing open RP decreased by 18% (from 2288 to 1870; P<.001), whereas hospitals providing minimally invasive RP increased by 191% (from 341 to 993; P<.001). The median open RP caseload per hospital decreased by 7% (from 68 to 63; P<.001), whereas the median caseload for hospitals providing minimally invasive RP declined by 17% (from 122 to 101; P<.001). The hospitals providing fewer than 50 minimally invasive RPs per year increased from 12% to 26% (from 144 of 1240 to 3020 of 11,644; P<.001).

CONCLUSION

Per capita utilization of RP in the United States has remained stable from 1998 to 2011. Rapid expansion of the use of minimally invasive RP has reduced open RP utilization rates and median annual hospital caseload.