Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave

Abstract

Objective. It remains uncertain whether the increased direct costs of robot-assisted laparoscopic radical prostatectomy (RALP) are outweighed by cost savings due to shorter postoperative hospital care and shorter sick leave. This study compared the length of sick leave after RALP with that after radical retropubic prostatectomy (RRP). Material and methods. In a cohort study, information on length of sick leave was retrieved for 274 working men undergoing radical prostatectomy (127 RALP and 147 RRP). Data on confounders such as physical workload, average salary, body mass index and disease characteristics were collected from the medical records. Cox regression models were used to compare the treatment groups. Results. The median number of days with sick leave was 11 in the RALP group and 49 in the RRP group. After adjustment for confounders, patients in the RALP group were twice as likely to return to work at any time during follow-up (hazard ratio 02.13, 95% confidence interval 1.62Á2.80). High physical workload, low salary and high tumour grade were more common in the RRP group and associated with longer sick leave. Conclusions. Patients in the RALP group had shorter postoperative hospital stay and less need for paid sick leave than patients in the RRP group. These data indicate that RALP shortens the convalescence. Part of this difference may, however, be attributable to different selection of patients and different a priori expectations among patients and their doctors. A prospective randomized study is advocated, although blinding is unfeasible.

Radical prostatectomy: initial experience with robot-assisted laparoscopic procedures at a large university hospital

“…Blood loss was significantly lower in the RALP group on both univariate and multivariate analyses, which indicates that this method reduces the surgical trauma. This is in concordance with previous studies [4,7,16] and may contribute to the shorter duration of both in-hospital stay and postoperative sick leave for RALP-treated patients [16,18].…”

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

“…Supporters of robotic surgery often cite a reduced LOS as an advantage to the patient and means for cost-savings [5, 9, 22–25]. In this study, the median LOS for RP and OP were equivalent.…”

Relationships between perioperative physical activity and urinary incontinence after radical prostatectomy: an observational study

“…A key proposed benefit of RALP is that, given the smaller incisions required, patients experience less pain, and ‘faster recovery and return to normal activities’ [14]. Indeed, randomized trials of ORP vs RALP have demonstrated that patients having RALP take less sick leave [25], and have a faster return to baseline quality of life [26]. There are, however inherent difficulties with blinding patients and health practitioners in such trials, and the possibility that that recovery might have been influenced by preconceived patient/practitioner expectations in those studies cannot be discounted.…”