Original article
Radical Prostatectomy Trends in the United States: 1998 to 2011

https://doi.org/10.1016/j.mayocp.2015.09.018Get rights and content

Abstract

Objective

To determine the incidence and distribution of radical prostatectomy (RP) in the United States over time.

Patients and Methods

We conducted a serial cross-sectional analysis of time trends using the Nationwide Inpatient Sample of adult men older than 45 years who underwent RP between January 1, 1998, and December 31, 2011.

Results

Weighted estimates revealed that 962,917 men underwent RP during the study period. The annual rate of RP remained relatively stable, from 1425 RPs per million in the period 1998 to 1999 to 1330 RPs per million in the period 2010 to 2011 (7% decrease; P=.90). The annual rate of open RP decreased from 1424 per million to 435 per million (P<.001), whereas the annual rate of minimally invasive RP increased from less than 1 per million to 895 per million (P<.001). Since 2006, hospitals providing open RP decreased by 18% (from 2288 to 1870; P<.001), whereas hospitals providing minimally invasive RP increased by 191% (from 341 to 993; P<.001). The median open RP caseload per hospital decreased by 7% (from 68 to 63; P<.001), whereas the median caseload for hospitals providing minimally invasive RP declined by 17% (from 122 to 101; P<.001). The hospitals providing fewer than 50 minimally invasive RPs per year increased from 12% to 26% (from 144 of 1240 to 3020 of 11,644; P<.001).

Conclusion

Per capita utilization of RP in the United States has remained stable from 1998 to 2011. Rapid expansion of the use of minimally invasive RP has reduced open RP utilization rates and median annual hospital caseload.

Section snippets

Study Data

After receiving approval from the Mayo Clinic Institutional Review Board, we extracted data for the period from 1998 to 2011 from the Nationwide Inpatient Sample (NIS) files of the Healthcare Cost and Utilization Project within the US Agency for Healthcare Research and Quality. The NIS contains discharge data both at the patient level and at the hospital level from states that participate in the Healthcare Cost and Utilization Project. Comprising data from approximately 1000 US hospitals

Results

Weighted estimates revealed that 962,917 men older than 45 years underwent RP at all nonfederally funded hospitals in the United States during the study period. The quarterly rate of total RPs in the United States remained stable during the study period, from 341 RPs per million adult men older than 45 years in the first quarter of 1998 to 337 RPs per million adult men older than 45 years in the last quarter of 2011 (incidence rate ratio [IRR], 1.00; 95% CI, 1.00-1.00; P=.90) (Figure 1). There

Discussion

Our study demonstrates several new and interesting findings about the volume and distribution of RP in the United States, with numerous potential clinical implications. First, the annual rate of RP remained relatively stable between 1998 and 2011. There was a somewhat expected, yet substantial, decline in the rate of open RP, but this decline was roughly paralleled by the rapid expansion of MI-RP, which was especially apparent after the fourth quarter of 2008 when the ICD-9 code for RP was

Conclusion

The per capita utilization rate of RP in the United States has remained stable from 1998 to 2011. The rapid expansion of MI-RP has led to a considerable reduction in the open RP utilization rate, as well as to a reduction in the median annual hospital caseload.

References (12)

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For editorial comment, see page 1

Grant Support: This research was supported by Desert Mountain's Cancer Awareness Through Research and Education organization (Scottsdale, Arizona), which generously supports the genitourinary research program at Mayo Clinic, Scottsdale, Arizona.

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