Perioperative Outcomes for Laparoscopic and Robotic Compared With Open Prostatectomy Using the National Surgical Quality Improvement Program (NSQIP) Database REPLY

OBJECTIVE To examine contemporary outcomes of minimally invasive radical prostatectomy (MIRP) compared with open prostatectomy, using a national, prospective perioperative database reflecting diverse practice settings. METHODS The National Surgical Quality Improvement Program database was queried from 2005 to 2010 for laparoscopic or robotic prostatectomy (Current Procedural Terminology code 55866) and open retropubic prostatectomy (Current Procedural Terminology codes 55840, 55842, 55845). Perioperative outcomes examined were surgical and total operation duration, transfusion rates, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality. RESULTS The study identified 5319 radical prostatectomies: 4036 MIRP and 1283 open. Although operative time was significantly longer in the MIRP group, there were significantly fewer perioperative blood transfusions and shorter mean length of stay. Major postoperative morbidity and mortality were 5% in the MIRP group and 9% in the open group (P < .001). Age, body mass index, presence of medical comorbidities, and open surgical technique were all independently predictive of major complications and mortality on multivariate analysis. CONCLUSION In a nationwide database of diverse medical centers, MIRP was associated with longer operative time, but a significantly decreased rate of blood transfusions, length of stay, perioperative complication rate, and mortality compared with open prostatectomy. The minimally invasive surgical approach was independently associated with significantly fewer complications and deaths on multivariate analysis. Compared with other administrative databases that capture only inpatient events, the National Surgical Quality Improvement Program identifies complications up to 30 days postoperatively, providing more detailed characterization of complications after prostatectomy. These data reflect contemporary practice patterns and suggest that MIRP can be performed with low perioperative morbidity. UROLOGY 82: 579-583, 2013. (C) 2013 Elsevier Inc.