Background To test contemporary rates and predictors of open conversion at minimally invasive (laparoscopic or robotic) radical prostatectomy (MIRP). Methods Within the National Inpatient Sample database (2008-2015) we identified all MIRP patients and patients that underwent open conversion at MIRP. First, estimated annual percentage changes (EAPC) tested temporal trends of open conversion. Second, multivariable logistic regression models predicted open conversion at MIRP. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results Of 57,078 MIRP patients, 368 (0.6%) underwent open conversion. The rates of open conversion decreased over time (from 1.80 to 0.38%; EAPC:-26.0%; p=0.003). In multivariable logistic regression models predicting open conversion, patient obesity (OR:2.10; p<0.001), frailty (OR:1.45; p=0.005) and Charlson Comorbidity Index (CCI)≥2 (OR:1.57; p=0.03) achieved independent predictor status. Moreover, compared to high volume hospitals, medium volume (OR:2.03; p<0.001) and low volume hospitals (OR:3.86; p<0.001) were associated with higher rates of open conversion. Last but not least, when the interaction between the number of patient risk factors (obesity and/or frailty and/or CCI≥2) and hospital volume was tested, a dose-response effect was observed. Specifically, the rates of open conversion ranged from 0.3% (patients with 0 risk factors treated at high volume hospitals) to 2.2% (patients with 2-3 risk factors treated at low volume hospitals). Conclusion Overall contemporary (2008-2015) rate of open conversion at MIRP was 0.6% and it was strongly associated with patient obesity, frailty, CCI≥2 and hospital surgical volume. In consequence, these parameters should be taken into account during preoperative patients counselling, as well as in clinical and administrative decision making.
Journal of endourology. 2020 Mar 17 [Epub ahead of print]
Stefano Luzzago, Giuseppe Rosiello, Angela Pecoraro, Marina Deuker, Franziska Stolzenbach, Francesco Alessandro Mistretta, Zhe Tian, Gennaro Musi, Emanuele Montanari, Shahrokh F Shariat, Fred Saad, Alberto Briganti, Ottavio De Cobelli, Pierre I Karakiewicz
IEO, 9290, Via Giuseppe Ripamonti 435, Milano, Italy, 20141; ., Milan, Italy; ., Azienda Ospedaliero Universitaria San Luigi Gonzaga, Urology Orbassano, IT, Regione Gonzole, 10, Orbassano, Turin, Piedmont, Turin, Italy, 10043; ., Hospital of the Goethe University Frankfurt, 14984, Urology, Theodor Stern Kai 7, Frankfurt am Main, Hessen, Germany, 60590; ., Hamburg, Germany; ., Istituto Europeo di Oncologia, 9290, Urology , Via Ripamonti 435, Milano, Italy, 20141., Montreal, Canada; ., European Institute of Oncology (IEO), Department of Urology, Milan, Italy; ., University of Milan, Urology, Via Antonio di Rudinì 8, Milan, United States, 20146; ., 1330 first avenue, 1024ny, New York, United States, 10021., Centre de recherche du CHUM, 177460, Montreal, Quebec, Canada; ., Milan, Italy; ., Eiropean Institute of Oncology, Milan, Italy; ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Urology, 1058, rue St-Denis, Montreal, Quebec, Canada, H2X 3J4; .