1806 PREDICTORS OF THE CONTEMPORARY USE OF MINIMALLY INVASIVE RADICAL PROSTATECTOMY

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You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 20121806 PREDICTORS OF THE CONTEMPORARY USE OF MINIMALLY INVASIVE RADICAL PROSTATECTOMY Gurdarshan S. Sandhu, Seth A. Strope, Adam S. Kibel, Pamela L. Owens, Youssef S. Tanagho, Dorina Kallogjeri, Sam B. Bhayani, and Kenneth G. Nepple Gurdarshan S. SandhuGurdarshan S. Sandhu St. Louis, MO More articles by this author , Seth A. StropeSeth A. Strope St. Louis, MO More articles by this author , Adam S. KibelAdam S. Kibel Boston, MA More articles by this author , Pamela L. OwensPamela L. Owens St. Louis, MO More articles by this author , Youssef S. TanaghoYoussef S. Tanagho St. Louis, MO More articles by this author , Dorina KallogjeriDorina Kallogjeri St. Louis, MO More articles by this author , Sam B. BhayaniSam B. Bhayani St. Louis, MO More articles by this author , and Kenneth G. NeppleKenneth G. Nepple St. Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1872AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The surgical approach to the treatment of prostate cancer has changed dramatically with the introduction and adoption of new surgical technology. Clinical and socioeconomic factors may influence the utilization of minimally invasive radical prostatectomy (MIRP). Using a population-based sample from the United States, we evaluated predictors of the choice of MIRP compared to open radical retropubic prostatectomy (RRP). METHODS Hospital discharge information (State Inpatient Databases from the Healthcare Cost and Utilization Project) from ten states (Arizona, California, Florida, Iowa, Maryland, Michigan, Nebraska, New Jersey, New York, Washington) was evaluated for 2009. Using ICD-9 procedural coding, patients who underwent radical prostatectomy for prostate cancer were identified. Prostatectomy was classified as MIRP based on the presence of a secondary code for laparoscopic or robotic surgery. Demographic and socioeconomic variables assessed were age, race, insurance type, geographic location (urban vs. rural) and median income by zip code. Medical comorbidity was evaluated by the modified Elixhauser method using the Agency for Healthcare Research and Quality (AHRQ) comorbidity measure. Predictors of MIRP were assessed by univariable logistic regression, and factors with p<0.10 were included in a multivariable model. RESULTS 27,399 radical prostatectomies were performed in 10 states in 2009, of which 18,185 were MIRP (66.4%). Differences were present in patients who underwent MIRP vs. RRP (Table 1). On multivariate analysis (Table 2), MIRP was less likely to be performed in men who were older, from rural or lower income areas, or had medical comorbidities. Table 1. Differences in patients undergoing MIRP and RRP Variable MIRP RRP p value Age (mean) 61.1 61.5 <0.0001 Race <0.0001 White 76.8% 72.2% Black 10.4% 11.5% Other 12.8% 16.4% Insurance <0.0001 Private 65.3% 59.8% Medicare 30.1% 31.9% Other 4.7% 8.4% Income quartile <0.0001 1st 15.8% 19.7% 2nd 21.3% 24.6% 3rd 27.1% 26.0% 4th 35.9% 29.7% Rural location 10.1% 14.3% <0.0001 Table 2. Predictors of MIRP in 2009 based on multivariate logistic regression analysis Variable Odds Ratio 95% CI p value Age (per year older) 0.99 0.99-0.99 0.02 Black race (vs. white) 0.95 0.86-1.04 0.28 Other race (vs. white) 0.77 0.71-0.84 <0.001 Medicare (vs. private) 0.99 0.92-1.07 0.85 Other payer (vs. private) 0.59 0.53-0.67 <0.001 Income quartile 1 (vs 4) 0.80 0.73-0.87 <0.001 Income quartile 2 (vs. 4) 0.83 0.77-0.89 <0.001 Income quartile 3 (vs. 4) 0.93 0.86-0.99 0.04 Rural (vs. urban) 0.71 0.64-0.77 <0.001 Chronic blood loss anemia 0.33 0.21-0.53 <0.001 Chronic deficiency anemia 0.50 0.43-0.58 <0.001 COPD 0.88 0.79-0.97 0.01 Diabetes complicated 0.65 0.48-0.86 0.003 Electrolyte abnormality 0.71 0.60-0.84 <0.001 Hypertension 0.93 0.88-0.99 0.02 Peripheral vascular disease 0.