PURPOSE: Despite increased utilization of Minimally Invasive Radical Prostatectomy (MIRP), open conversion (OC) may occur due to surgical complications, surgeon inexperience or failure to progress.
Here we use nationally representative data to quantify the impact of OC compared to nonconverted MIRP and open radical prostatectomy (ORP) and identify predictors of OC.
MATERIALS AND METHODS: Years 2004 - 2010 of the Nationwide Inpatient Sample were queried for patients undergoing radical prostatectomy to analyze the association of OC during MIRP with Clavien complications. Multivariate regression models yielded significant predictors of OC.
RESULTS: From 2004-2010, 134,398 (95%CI:111,509-157,287) MIRPs were performed with a 1.8% (95%CI:1.4%-2.1%) OC rate, translating to 2,360 (95%CI:2001-2720) conversions. OC patients had a longer length of stay (4.17 vs. 1.71, p< 0.001) and higher hospital charges ($51,049 vs. $37,418, p< 0.001) than nonconverted patients. 45.2% of OC patients experienced a complication compared to 7.2% and 12.9% of MIRP and ORP patients, respectively (p< 0.001). After adjusting for age and comorbidities, OC was associated with significantly increased odds of a Clavien grade 1, 2, 3, and 4 complication when compared to both nonconverted MIRP and ORP (OR range: 2.913-15.670, p< 0.001). Significant multivariate predictors of OC were the following (all p< 0.01): obesity (OR:1.916), adhesions (OR:3.060), anemia (5.692), and surgeon MIRP volume < 25 cases/year (OR:7.376).
CONCLUSIONS: OC during MIRP is associated with a higher than expected increase in complications compared to ORP and MIRP after adjusting for age and comorbidities. External validation of the OC predictors may prove useful in minimizing OC during MIRP.
Written by:
Sharma V, Meeks JJ. Are you the author?
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Reference: J Urol. 2014 Jun 14. pii: S0022-5347(14)03781-1.
doi: 10.1016/j.juro.2014.06.029
PubMed Abstract
PMID: 24936721
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