Department of Urology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
Department of Medical Statistics and Biometry, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
Prostate Cancer Prostatic Dis. 2016 Dec;19(4):412-416. doi: 10.1038/pcan.2016.34. Epub 2016 Aug 23.
To assess trends in the distribution of patients for radical prostatectomy in Germany from 2006 to 2013 and the impact of robotic surgery on annual caseloads. We hypothesized that the advent of robotics and the establishment of certified prostate cancer centers caused centralization in the German radical prostatectomy market.
Using remote data processing we analyzed the nationwide German billing data from 2006 to 2013. We supplemented this database with additional hospital characteristics like the prostate cancer center certification status. Inclusion criteria were a prostate cancer diagnosis combined with radical prostatectomy. Hospitals with certification or a surgical robot in 2009 were defined as 'early' group. Linear covariant-analytic models were applied to describe trends over time.
Annual radical prostatectomy numbers declined from 28 374 (2006) to 21 850 (2013). High-volume hospitals (⩾100 cases) decreased from 87 (22.0%) in 2006 to 43 (10.4%) in 2013. Low-volume hospitals (<50 cases) increased from 193 (48.7%) to 280 (67.4%). Mean radical prostatectomy caseloads of hospitals with early vs without certification declined from 155 to 130 vs 77 to 39 (P=0.021 for trend comparison). Early robotic hospitals maintained their volume >200 cases per year contrary to the overall trend (P<0.001 for trend comparison). A multivariate model for caseload numbers of 2013 indicated a robotic system to be the most important factor for higher caseloads (multiplication factor 7.3; 95% confidence interval: 6.6-8.0). A prostate cancer center certification (multiplication factor 1.6; 95% confidence interval: 1.50-1.59) had a much smaller impact.
We found decentralization of radical prostatectomy in Germany. The driving force for this development might consist in the overall decline of radical prostatectomy numbers. The most important factor for achieving higher caseloads was the presence of a robotic system. In order to optimize outcomes of radical prostatectomy additional health policy measures might be necessary.
评估 2006 年至 2013 年德国根治性前列腺切除术患者分布趋势，以及机器人手术对年手术量的影响。我们假设机器人技术的出现和认证前列腺癌中心的建立导致了德国根治性前列腺切除术市场的集中化。
使用远程数据处理，我们分析了 2006 年至 2013 年全国性的德国计费数据。我们用额外的医院特征，如前列腺癌中心认证状态，补充了这个数据库。纳入标准为前列腺癌诊断合并根治性前列腺切除术。2009 年有认证或手术机器人的医院被定义为“早期”组。应用线性协变量分析模型来描述随时间的变化趋势。
每年根治性前列腺切除术的数量从 2006 年的 28374 例下降到 2013 年的 21850 例。高容量医院（≥100 例）从 2006 年的 87 家（22.0%）下降到 2013 年的 43 家（10.4%）。低容量医院（<50 例）从 193 家增加到 280 家（P=0.021 用于趋势比较）。早期有认证 vs 无认证的医院根治性前列腺切除术例数从 155 例降至 130 例，而无认证的医院从 77 例降至 39 例（趋势比较 P=0.021）。早期机器人医院的手术量仍保持在每年>200 例，与总体趋势相反（趋势比较 P<0.001）。2013 年病例数的多变量模型表明，机器人系统是增加病例数的最重要因素（倍增因子 7.3；95%置信区间：6.6-8.0）。前列腺癌中心认证（倍增因子 1.6；95%置信区间：1.50-1.59）的影响要小得多。
我们发现德国根治性前列腺切除术的分散化。这一发展的驱动力可能在于根治性前列腺切除术数量的总体下降。实现更高手术量的最重要因素是存在机器人系统。为了优化根治性前列腺切除术的结果，可能需要采取额外的卫生政策措施。
