Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: Results from a privately insured patient population

S. P. Kim, C. P. Gross, M. C. Smaldone, L. C. Han, H. Van Houten, Y. Lotan, R. S. Svatek, R. H. Thompson, Robert Jeffrey Karnes, Q. D. Trinh, A. Kutikov, Nilay D Shah

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer. METHODS: Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches. RESULTS: Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P < 0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P < 0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P < 0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P = 0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P < 0.001). CONCLUSIONS: Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.

Original languageEnglish (US)
Pages (from-to)13-17
Number of pages5
JournalProstate Cancer and Prostatic Diseases
Volume18
Issue number1
DOIs
StatePublished - Mar 11 2015

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Prostatectomy
Population
Prostatic Neoplasms
Length of Stay
Robotics
Patient Readmission
Insurance
Odds Ratio
Regression Analysis
Databases

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Cancer Research

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Perioperative outcomes and hospital reimbursement by type of radical prostatectomy : Results from a privately insured patient population. / Kim, S. P.; Gross, C. P.; Smaldone, M. C.; Han, L. C.; Van Houten, H.; Lotan, Y.; Svatek, R. S.; Thompson, R. H.; Karnes, Robert Jeffrey; Trinh, Q. D.; Kutikov, A.; Shah, Nilay D.

In: Prostate Cancer and Prostatic Diseases, Vol. 18, No. 1, 11.03.2015, p. 13-17.

Research output: Contribution to journalArticle

Kim, SP, Gross, CP, Smaldone, MC, Han, LC, Van Houten, H, Lotan, Y, Svatek, RS, Thompson, RH, Karnes, RJ, Trinh, QD, Kutikov, A & Shah, ND 2015, 'Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: Results from a privately insured patient population', Prostate Cancer and Prostatic Diseases, vol. 18, no. 1, pp. 13-17. https://doi.org/10.1038/pcan.2014.38
Kim, S. P. ; Gross, C. P. ; Smaldone, M. C. ; Han, L. C. ; Van Houten, H. ; Lotan, Y. ; Svatek, R. S. ; Thompson, R. H. ; Karnes, Robert Jeffrey ; Trinh, Q. D. ; Kutikov, A. ; Shah, Nilay D. / Perioperative outcomes and hospital reimbursement by type of radical prostatectomy : Results from a privately insured patient population. In: Prostate Cancer and Prostatic Diseases. 2015 ; Vol. 18, No. 1. pp. 13-17.
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abstract = "BACKGROUND: With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer. METHODS: Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches. RESULTS: Overall, 8981 (51.0{\%}) and 8629 (49.0{\%}) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9{\%} in 2003 to 72.5{\%} in 2010 (P < 0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P < 0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P < 0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P = 0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P < 0.001). CONCLUSIONS: Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70{\%} of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.",
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T2 - Results from a privately insured patient population

AU - Kim, S. P.

AU - Gross, C. P.

AU - Smaldone, M. C.

AU - Han, L. C.

AU - Van Houten, H.

AU - Lotan, Y.

AU - Svatek, R. S.

AU - Thompson, R. H.

AU - Karnes, Robert Jeffrey

AU - Trinh, Q. D.

AU - Kutikov, A.

AU - Shah, Nilay D

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N2 - BACKGROUND: With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer. METHODS: Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches. RESULTS: Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P < 0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P < 0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P < 0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P = 0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P < 0.001). CONCLUSIONS: Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.

AB - BACKGROUND: With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer. METHODS: Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches. RESULTS: Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P < 0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P < 0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P < 0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P = 0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P < 0.001). CONCLUSIONS: Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.

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