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Comparisons of perioperative outcomes and costs between open and laparoscopic radical prostatectomy: A propensity‐score matching analysis based on the J apanese D iagnosis P rocedure C ombination database
Author(s) -
Sugihara Toru,
Yasunaga Hideo,
Horiguchi Hiromasa,
Tsuru Nobuo,
Ihara Hiroyuki,
Fujimura Tetsuya,
Nishimatsu Hiroaki,
Ohe Kazuhiko,
Fushimi Kiyohide,
Homma Yukio
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12079
Subject(s) - medicine , cystography , perioperative , laparoscopic radical prostatectomy , propensity score matching , prostatectomy , laparoscopy , urology , complication , surgery , prostate cancer , cancer , urinary system
We compared perioperative outcomes and costs between open and laparoscopic radical prostatectomy for prostate cancer. The J apanese D iagnosis P rocedure C ombination database, including cases from 2007 to 2010, was used by one‐to‐one propensity‐score matching. The following items were compared: complication rate; homologous and autologous transfusion rate; first cystography day and cystography repeat rate; anesthesia time; postoperative length of stay; and costs. Multivariate analyses were carried out by including age, C harlson C omorbidity I ndex, T stage, hospital volume and hospital academic status as variables. As a result, among 15 616 open and 1997 laparoscopic radical prostatectomies, 1627 propensity‐score matched pairs were generated. The laparoscopic approach showed a better overall complication rate (3.4% vs 5.0%), homologous transfusion rate (3.3% vs 9.2%), autologous transfusion rate (44.9% vs 79.3%), first cystography day (mean 6th vs 7th day), mean postoperative length of stay (mean 11 vs 13 days), and cost without surgery and anesthesia (mean $7965 vs $9235; all P < 0.001). Anesthesia time was longer (mean 345 vs 285 min) and total cost was higher (mean $14 980 vs $12 356) for the laparoscopic approach (both P < 0.001). The secondary cystography rates were comparable between the groups (18.3% vs 15.7%, P = 0.144). The multivariate analyses showed similar trends. In conclusion, these findings confirm several benefits of laparoscopy over open approach for radical prostatectomy.