Guillaume Ploussard1,2, Annabelle Grabia3, Eric Barret4, Jean-Baptiste Beauval5, Laurent Brureau6,7, Gilles Créhange8, Charles Dariane9, Gaëlle Fiard10, Gaëlle Fromont11, Mathieu Gauthé12, Romain Mathieu13, Raphaële Renard-Penna14, Guilhem Roubaud15, Alain Ruffion16,17, Paul Sargos18, Morgan Rouprêt19, Charles-Edouard Lequeu3. 1. Department of Urology, La Croix du Sud Hôpital, 52, Chemin de Ribaute, 31130, Quint Fonsegrives, France. g.ploussard@gmail.com. 2. IUCT-O, Toulouse, France. g.ploussard@gmail.com. 3. Department of Public Health, PMSI, Ramsay Santé, Paris, France. 4. Department of Urology, Institut Mutualiste Montsouris, Paris, France. 5. Department of Urology, La Croix du Sud Hôpital, 52, Chemin de Ribaute, 31130, Quint Fonsegrives, France. 6. Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, 97110, Pointe-à-Pitre, France. 7. Inserm, EHESP, Irset (Institut de Recherche en SantéEnvironnement et Travail)-UMR_S 1085, University of Rennes, Rennes, France. 8. Department of Radiotherapy, Institut Curie, Paris, France. 9. Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris University-U1151 Inserm-INEM, Necker, Paris, France. 10. Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France. 11. Department of Pathology, CHRU Tours, Tours, France. 12. UMR 1153, Unité de Recherche Clinique en Économie de la Santé, CRESS METHODS INSERM, Paris, France. 13. Department of Urology, CHU Rennes, Rennes, France. 14. AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, F-75013, Paris, France. 15. Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France. 16. Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France. 17. Equipe 2-Centre d'Innovation en cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, Lyon, France. 18. Department of Radiotherapy, Institut Bergonié, 33000, Bordeaux, France. 19. AP-HP, Urology, GRC 5 Predictive Onco-Uro, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France.
Abstract
OBJECTIVE: Annual countrywide data are scarce when comparing surgical approaches in terms of hospital stay outcomes and costs for radical prostatectomy (RP). We aimed to assess the impact of surgical approach on post-operative outcomes and costs after RP by comparing open (ORP), laparoscopic (LRP), and robot-assisted (RARP) RP in the French healthcare system. PATIENTS AND METHODS: Data from all patients undergoing RP in France in 2020 were extracted from the central database of the national healthcare system. Primary endpoints were length of hospital stay (LOS including intensive care unit (ICU) stay if present), complications (estimated by severity index), hospital readmission rates (at 30 and 90 days), and direct costs of initial stay. RESULTS AND LIMITATIONS: A total of 19,018 RPs were performed consisting in ORP in 21.1%, LRP in 27.6%, and RARP in 51.3% of cases. RARP was associated with higher center volume (p < 0.001), lower complication rates (p < 0.001), shorter LOS (p < 0.001), and lower readmission rates (p = 0.004). RARP was associated with reduced direct stay costs (2286 euros) compared with ORP (4298 euros) and LRP (3101 euros). The main cost driver was length of stay. The main limitations were the lack of mid-term data, readmission details, and cost variations due to surgery system. CONCLUSIONS: This nationwide analysis demonstrates the benefits of RARP in terms of post-operative short-term outcomes. Higher costs related to the robotic system appear to be balanced by patient care improvements and reduced direct costs due to shorter LOS.
OBJECTIVE: Annual countrywide data are scarce when comparing surgical approaches in terms of hospital stay outcomes and costs for radical prostatectomy (RP). We aimed to assess the impact of surgical approach on post-operative outcomes and costs after RP by comparing open (ORP), laparoscopic (LRP), and robot-assisted (RARP) RP in the French healthcare system. PATIENTS AND METHODS: Data from all patients undergoing RP in France in 2020 were extracted from the central database of the national healthcare system. Primary endpoints were length of hospital stay (LOS including intensive care unit (ICU) stay if present), complications (estimated by severity index), hospital readmission rates (at 30 and 90 days), and direct costs of initial stay. RESULTS AND LIMITATIONS: A total of 19,018 RPs were performed consisting in ORP in 21.1%, LRP in 27.6%, and RARP in 51.3% of cases. RARP was associated with higher center volume (p < 0.001), lower complication rates (p < 0.001), shorter LOS (p < 0.001), and lower readmission rates (p = 0.004). RARP was associated with reduced direct stay costs (2286 euros) compared with ORP (4298 euros) and LRP (3101 euros). The main cost driver was length of stay. The main limitations were the lack of mid-term data, readmission details, and cost variations due to surgery system. CONCLUSIONS: This nationwide analysis demonstrates the benefits of RARP in terms of post-operative short-term outcomes. Higher costs related to the robotic system appear to be balanced by patient care improvements and reduced direct costs due to shorter LOS.
Authors: Weibin Hou; Bingzhi Wang; Lei Zhou; Lan Li; Chao Li; Peng Yuan; Wei Ouyang; Hanyu Yao; Jin Huang; Kun Yao; Long Wang Journal: Front Surg Date: 2022-09-28