Background: Due to recent advances in minimally invasive surgical techniques, robotic-assisted radical prostatectomy (RARP) has become the primary treatment option in prostate cancer.
However, RARP requires patients to be placed in a steep Trendelenberg position, which presents multiple opportunities for complications relating to the positioning of the patient. Our study aims to study the prevalence and demographic predictors of these positioning complications and assess their impacts on length of stay (LOS) and total cost.
Methods: We included patients who underwent RP from 2008-2009 using data extracted from the Nationwide Inpatient Sample database. Positioning complications (eye, nerve, compartment syndrome/rhabdomyolysis) were identified using patient-level diagnosis and procedural ICD-9CM codes. Logistic regression models assessed relationships between demographic factors and occurrence of complications, and the effects of them on prolonged LOS and total inpatient cost.
Results: Positioning complications occurred in 0.4% of cases with eye complications contributing the most to this frequency. Laparoscopic RP procedure (OR = 2.88, p < 0.01) and comorbidities (OR = 2.34, p < 0.01) were highly associated with increased odds of positioning complication occurrence, whereas RARP procedures (OR = 0.93, p > 0.4) were not associated with positioning complications. Having positioning complications increased a patient's odds of having increased inpatient costs and extended LOS by almost 400% and 300%, respectively.
Conclusion: The steep Trendelenberg position utilized in RARP was not shown to be associated with patient positioning-related complications in this sample. RARP is not associated with patient positioning-related complications in this nationally estimably sample. The steep Trendelenberg position appears to be a safe option for surgical positioning. However, the occurrence of positioning-related complications place huge burdens on total inpatient costs and LOS.
Written by:
Wen T, Deibert CM, Siringo F, Spencer BA. Are you the author?
Columbia University Mailman School of Public Health, Epidemiology, New York City, New York, United States.
Reference: J Endourol. 2014 Jan 15. Epub ahead of print.
doi: 10.1089/end.2013.0623
PubMed Abstract
PMID: 24428586
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