Robotic surgery improves transfusion rate and perioperative outcomes using a broad implementation process and multiple surgeon learning curves
Introduction: Data from a randomized trial suggest transfusion rates are similar for robotic and open prostatectomy. The objective of this study was to compare perioperative outcomes of robotic and open prostatectomy at a Canadian academic centre.
Methods: A retrospective review of all prostatectomies performed by all surgeons at The Ottawa Hospital between 2009 and 2016 was completed. Cases and outcomes were identified using an administrative data warehouse. Extracted data included patient factors (age, body mass index, American Society of Anesthesiologists score, Elixhauser comorbidity score), operative factors (length of operation, surgical approach, anesthesia type), and perioperative outcomes (length of recovery room and hospital stay, transfusion rate, hospital cost). Baseline characteristics and outcomes were compared between robotic and open surgical approaches. The primary outcome was transfusion during the index admission.
Results: A total of 1606 prostatectomies were performed by 12 surgeons during the study period (840 robotic, 766 open). The rate of transfusion was lower in patients undergoing robotic compared to open surgery (0.6% vs. 11.2%; p<0.001). The robotic prostatectomy cohort had a shorter length of stay in the recovery room (155.7 vs. 231.1 minutes; p<0.001) and shorter length of hospital admission (1.4 vs. 2.8 days; p<0.001). Hospital costs per case were approximately $800 more for robotic prostatectomy ($11 475 vs. $10 656; p<0.001).
Conclusions: This hospital-wide analysis revealed that robotic prostatectomy is associated with a lower transfusion rate compared to the open approach. Further studies emphasizing patient-reported outcomes are needed.
You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:
- Post the Article on any Web site
- Translate or authorize a translation of the Article
- Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
- Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.
The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.
You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.
The CUA also requires you to warrant the following:
- That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
- That all individuals who have made a substantive contribution to the article are acknowledged;
- That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
- That the Article does not libel or violate the privacy rights of any third party.