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Clinical Research

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

Prostate Cancer and Prostatic Diseases volume 18, pages 13–17 (2015)Cite this article

Subjects

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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Authors and Affiliations

  1. University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH, USA

    S P Kim

  2. Yale University, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT, USA

    C P Gross

  3. Center for Reducing Racial Disparities, Case Western Reserve University, Cleveland, OH, USA

    S P Kim

  4. Department of Internal Medicine, Yale University, New Haven, CT, USA,

    C P Gross

  5. Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA

    M C Smaldone & A Kutikov

  6. Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA

    L C Han, H Van Houten & N D Shah

  7. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Y Lotan

  8. Department of Urology, UT Health Science Center San Antonio, San Antonio, TX, USA,

    R S Svatek

  9. Department of Urology, Mayo Clinic, Rochester, MN, USA

    R H Thompson & R J Karnes

  10. Division of Urologic Surgery, Harvard Medical School, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA

    Q-D Trinh

  11. Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, MN, USA

    N D Shah

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  1. S P Kim
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Corresponding author

Correspondence to S P Kim.

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Competing interests

SPK was supported by a career development award from the Conquer Cancer Foundation of the American Society of Clinical Oncology. The remaining authors declare no conflict of interest.

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Kim, S., Gross, C., Smaldone, M. et al. Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: results from a privately insured patient population. Prostate Cancer Prostatic Dis 18, 13–17 (2015). https://doi.org/10.1038/pcan.2014.38

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