Simon Ross M, Howard Lauren E, Moreira Daniel M, Terris Martha K, Kane Christopher J, Aronson William J, Amling Christopher L, Cooperberg Matthew R, Freedland Stephen J
Department of Urology, University of South Florida College of Medicine, Tampa, Florida, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
Int J Urol. 2017 Aug;24(8):618-623. doi: 10.1111/iju.13393. Epub 2017 Jul 11.
To better predict operative time using patient/surgical characteristics among men undergoing radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy in order to achieve more efficient operative scheduling and potentially decrease costs in the Veterans Health System.
We analyzed 2619 men treated with radical retropubic prostatectomy (n = 2005) or robot-assisted laparoscopic prostatectomy (n = 614) from 1993 to 2013 from six Veterans Affairs Hospitals in the Shared Equal Access Regional Cancer Hospital database. Age, body mass index, race, biopsy Gleason, prostate weight, undergoing a nerve-sparing procedure or lymph node dissection, and hospital surgical volume were analyzed in multivariable linear regression to identify predictors of operative time and to quantify the increase/decrease observed.
In men undergoing radical retropubic prostatectomy, body mass index, black race, prostate weight and a lymph node dissection all predicted longer operative times (all P ≤ 0.004). In men undergoing robot-assisted laparoscopic prostatectomy, biopsy Gleason score and a lymph node dissection were associated with increased operative time (P ≤ 0.048). In both surgical methods, a lymph node dissection added 25-40 min to the operation. Also, in both, each additional operation per year per center predicted a 0.80-0.89-min decrease in operative time (P ≤ 0.001).
Overall, several factors seem to be associated with quantifiable changes in operative time. If confirmed in future studies, these findings can allow for a more precise estimate of operative time, which could decrease the overall cost to the patient and hospital by aiding in operating room time management.
利用耻骨后根治性前列腺切除术或机器人辅助腹腔镜前列腺切除术患者的患者/手术特征，更好地预测手术时间，以实现更高效的手术安排，并有可能降低退伍军人医疗系统的成本。
我们分析了1993年至2013年期间，来自共享平等访问区域癌症医院数据库中六家退伍军人事务医院的2619名接受耻骨后根治性前列腺切除术（n = 2005）或机器人辅助腹腔镜前列腺切除术（n = 614）的男性患者。在多变量线性回归中分析年龄、体重指数、种族、活检Gleason评分、前列腺重量、是否进行保留神经手术或淋巴结清扫以及医院手术量，以确定手术时间的预测因素，并量化观察到的增加/减少情况。
在接受耻骨后根治性前列腺切除术的男性患者中，体重指数、黑人种族、前列腺重量和淋巴结清扫均预测手术时间更长（所有P≤0.004）。在接受机器人辅助腹腔镜前列腺切除术的男性患者中，活检Gleason评分和淋巴结清扫与手术时间增加相关（P≤0.048）。在两种手术方法中，淋巴结清扫都会使手术增加25 - 40分钟。此外，在两种手术中，每个中心每年每增加一台手术，预测手术时间会减少0.80 - 0.89分钟（P≤0.001）。
总体而言，几个因素似乎与手术时间的可量化变化相关。如果在未来研究中得到证实，这些发现可以更精确地估计手术时间，通过辅助手术室时间管理，降低患者和医院的总体成本。
