Patterns of adoption of robotic radical prostatectomy in the United States and England

Abstract

Objectives: To compare patterns of technological adoption of minimally invasive surgery for radical prostatectomy across the United States and England. Data Sources: We examine radical prostatectomy in the United States and England between 2005 and 2017, using de-identified administrative claims data from the OptumLabs Data Warehouse in the United States and the Hospital Episodes Statistics in England. Study Design: We conducted a longitudinal analysis of robotic, laparoscopic, and open surgery for radical prostatectomy. We compared the trends of adoption over time within and across countries. Next, we explored whether differential adoption patterns in the two health systems are associated with differences in volumes and patient characteristics. Finally, we explored the relationship between these adoption patterns and length of stay, 30-day readmission, and urology follow-up visits. Data Collection: Open, laparoscopic, and robotic radical prostatectomies are identified using Office of Population Censuses and Surveys Classification of Interventions and Procedures (OPCS) codes in England and International Classification of Diseases ninth revision (ICD9), ICD10, and Current Procedural Terminology (CPT) codes in the United States. Principal Findings: We identified 66,879 radical prostatectomies in England and 79,358 in the United States during 2005-2017. In both countries, open surgery dominates until 2009, where it is overtaken by minimally invasive surgery. The adoption of robotic surgery is faster in the United States. The adoption rates and, as a result, the observed centralization of volume, have been different across countries. In both countries, patients undergoing radical prostatectomies are older and have more comorbidities. Minimally invasive techniques show decreased length of stay and 30-day readmissions compared to open surgery. In the United States, robotic approaches were associated with lower length of stay and readmissions when compared to laparoscopic. Conclusions: Robotic surgery has become the standard approach for radical proctectomy in the United States and England, showing decreased length of stay and in 30-day readmissions compared to open surgery. Adoption rates and specialization differ across countries, likely a product of differences in cost-containment efforts.

Trends in surgical treatment for prostate cancer: Analysis of National Database Open Data in Japan

“…We further found that 5,501 (22.8%) and 4,338 (22.1%) prostatectomies were performed without the robotic systems in 2019 and 2020, respectively. More than 500 robotic systems have been introduced in Japanese hospitals, and the prevalence of RARP is almost equivalent to that in the United States and England (5).…”

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

“…As previously described, there has been substantial growth in robotic procedures throughout the world. In a review of data from the OptumLabs Data Warehouse in the United States and the Hospital Episodes Statistics in England, investigators demonstrated that robotic surgery has become the standard approach for radical prostatectomy in the United States and England [ 13 ]. Similarly, utilization of robotic proctectomy for rectal cancer has also steadily increased [ 14 ].…”

“…However, reductions in LOS for robotic procedures have not been consistently reported in prior analyses. For example, in an analysis of patients with rectal cancer investigators reviewed claims data from 2005 through 2017, reporting decreased LOS for robotic surgery as compared to open surgery [ 13 ]. In contrast, although the lung cancer literature reveals reductions in hospital LOS for minimally invasive approaches as compared to open lung surgery [ 8 ], analyses of robotic lung surgery have not demonstrated appreciable gains in LOS as compared to VATS [ 2 , 15 ].…”

“…Our study identified lower readmission rates when patients underwent minimally invasive procedures for colorectal, lung, and kidney cancer, with additional improvements for those patients who underwent robotic procedures. A 2017 study of robotic prostate surgery revealed a decreased LOS and 30-day readmissions for robotic surgery as compared to open surgery [ 13 ]. Similarly, reductions in readmission were noted for obese patients with robotic colorectal cancer procedures in a meta-analysis of laparoscopic versus robotic surgery [ 27 ].…”

Robot‐assisted radical prostatectomy in Aotearoa New Zealand: equity, quality, and workforce

“…Robot‐assisted radical prostatectomy (RARP) for prostate cancer is now well‐established in settings where robotic surgical systems are available. The number of RARP per year overtook open radical prostatectomy (ORP) in 2009 in the United States of America (U.S.A), 1 in 2012 in England, 2 and in 2015 in Australia 3 . The proportion of RARP increased to 85% in the United States in 2013, 1 93% in England in 2018, 2 and 65% in Australia in 2019 3 .…”