Background
Methods
Data source
Study population
Variables
Statistical analysis
Results
Study population
Variables | All patients (N = 136,790) | Non-CKD (n = 134,751) | CKD (n = 1,766) | ESRD (n = 273) | p-value1 |
---|---|---|---|---|---|
Surgical approach | <.001 | ||||
Robot-assisted | 58703 (43) | 57614 (42.8) | 957 (54.1) | 132 (48.5) | |
Open | 78087 (57) | 77137 (57.2) | 809 (45.9) | 141 (51.5) | |
Demographic data | |||||
Age | 61.37 ± 0.05 | 61.34 ± 0.05 | 64.5 ± 0.18 | 60.34 ± 0.4 | <.001 |
Race | <.001 | ||||
Missing | 22526 (16.4) | 22230 (16.5) | 265 (14.9) | 31 (11.3) | |
White | 87803 (64.3) | 86795 (64.5) | 904 (51.3) | 104 (38.2) | |
Black | 13597 (9.9) | 13078 (9.7) | 423 (23.9) | 96 (35.3) | |
Hispanic | 6802 (5) | 6685 (4.9) | 92 (5.2) | 25 (9) | |
Other | 6062 (4.4) | 5963 (4.4) | 82 (4.6) | 17 (6.2) | |
Income | <.001 | ||||
Missing | 3506 (2.6) | 3469 (2.6) | 32 (1.8) | 5 (1.9) | |
0-25th percentile | 24745 (18) | 24257 (18) | 408 (23.2) | 80 (29.4) | |
26th to 50th percentile | 30884 (22.5) | 30363 (22.5) | 447 (25.4) | 74 (27.1) | |
51st to 75th percentile | 35469 (25.9) | 34987 (26) | 422 (23.9) | 60 (21.8) | |
76th to 100th percentile | 42186 (31) | 41675 (31) | 457 (25.7) | 54 (19.8) | |
Insurance status | <.001 | ||||
Missing | 256 (0.2) | 254 (0.2) | 1 (0.1) | 1 (0.4) | |
Medicare/Medicaid | 45803 (33.5) | 44683 (33.1) | 938 (53.2) | 182 (66.3) | |
Private/HMO | 84938 (62.1) | 84089 (62.4) | 765 (43.2) | 84 (31.1) | |
Self-pay/no-charge/other | 5793 (4.2) | 5725 (4.2) | 62 (3.5) | 6 (2.2) | |
Hospital characteristics | |||||
Bed size | .27 | ||||
Missing | 720 (0.5) | 703 (0.5) | 15 (0.8) | 2 (0.8) | |
Small | 14495 (10.3) | 14280 (10.3) | 191 (10.4) | 24 (8.3) | |
Medium | 28040 (20.7) | 27590 (20.67) | 397 (22.9) | 53 (19.7) | |
Large | 93535 (68.5) | 92178 (68.5) | 1163 (65.9) | 194 (71.3) | |
Location and teaching status | .02 | ||||
Missing | 720 (0.5) | 703 (0.5) | 15 (0.8) | 2 (0.8) | |
Rural | 6294 (4.6) | 6203 (4.6) | 84 (4.7) | 7 (2.5) | |
Urban nonteaching | 40144 (29.1) | 39571 (29.1) | 518 (29.3) | 55 (19.6) | |
Urban teaching | 89632 (65.9) | 88274 (65.8) | 1149 (65.2) | 209 (77.2) | |
Region | <.001 | ||||
Northeast | 25341 (19.2) | 25046 (19.3) | 237 (13.9) | 58 (22.1) | |
Midwest | 32953 (24.4) | 32348 (24.3) | 543 (30.9) | 62 (22.5) | |
South | 48141 (34.7) | 47480 (34.7) | 567 (31.8) | 94 (34) | |
West | 30355 (21.8) | 29877 (21.7) | 419 (23.4) | 59 (21.4) | |
Radical prostatectomy caseloada | <.001 | ||||
0-25th percentile | 32941 (24.1) | 32264 (24) | 606 (34.6) | 71 (25.5) | |
26th to 50th percentile | 35214 (25.7) | 34646 (25.7) | 491 (27.8) | 77 (28.1) | |
51st to 75th percentile | 34151 (24.8) | 33741 (24.9) | 347 (19.6) | 63 (23.4) | |
76th to 100th percentile | 34484 (25.3) | 34100 (25.4) | 322 (18) | 62 (23.1) | |
Comorbidities | |||||
Elixhauser comorbidity scoreb | <.001 | ||||
0-25th percentile | 48823 (35.7) | 48811 (36.2) | 11 (0.6) | 1 (0.4) | |
26th to 50th percentile | 50502 (36.9) | 50366 (37.4) | 131 (7.4) | 5 (1.8) | |
51st to 75th percentile | 25410 (18.6) | 24894 (18.5) | 471 (26.6) | 45 (16.4) | |
76th to 100th percentile | 12055 (8.8) | 10680 (7.8) | 1153 (65.3) | 222 (81.4) | |
Anemia | 4774 (3.5) | 4362 (3.2) | 287 (16.2) | 125 (45.8) | <.001 |
Congestive heart failure | 820 (0.6) | 718 (0.5) | 82 (4.7) | 20 (7.3) | <.001 |
Chronic pulmonary disease | 10580 (7.7) | 10310 (7.7) | 241 (13.8) | 29 (10.7) | <.001 |
Coagulopathy | 879 (0.6) | 815 (0.6) | 56 (3.2) | 8 (2.9) | <.001 |
Depression | 5459 (4.0) | 5353 (3.9) | 93 (5.3) | 13 (4.8) | .02 |
Diabetes | 17106 (12.5) | 16405 (12.2) | 602 (33.9) | 99 (36.4) | <.001 |
Hypertension | 66931 (50.9) | 65151 (48.3) | 1521 (86.1) | 259 (94.8) | <.001 |
Fluid/electrolyte disorders | 3755 (2.8) | 3449 (2.5) | 254 (14.4) | 52 (19.3) | <.001 |
Obesity | 9411 (6.9) | 9101 (6.8) | 279 (15.7) | 31 (11.5) | <.001 |
Peripheral vascular disorders | 1465 (1.1) | 1368 (1.0) | 89 (5.0) | 8 (3.1) | <.001 |
Weight loss | 230 (0.2) | 209 (0.2) | 18 (1.0) | 3 (1.0) | <.001 |
Clinical outcomes | All patients (N = 136,790) | Non-CKD (n = 134,751) | CKD (n = 1,766) | ESRD (n = 273) | p-value1 |
---|---|---|---|---|---|
Length of stay | 2.11 ± 0.02 | 2.09 ± 0.02 | 3.16 ± 0.11 | 4.33 ± 0.41 | <.001 |
Postoperative complication | 12434 (9.1) | 12011 (8.9) | 364 (20.6) | 59 (21.6) | <.001 |
In-hospital mortality | 55 (0.04) | 51 (0.04) | 2 (0.1) | 2 (0.7) | <.001 |
Cardiovascular complications | 943 (0.7) | 889 (0.7) | 46 (2.7) | 8 (3) | <.001 |
Bleeding complications | 7974 (5.8) | 7708 (5.7) | 230 (13) | 36 (13.2) | <.001 |
Pulmonary complications | 1251 (0.9) | 1158 (0.9) | 75 (4.2) | 18 (6.5) | <.001 |
Infection/sepsis | 303 (0.2) | 273 (0.2) | 22 (1.2) | 8 (3) | <.001 |
DVT / Pulmonary embolism | 204 (0.2) | 189 (0.1) | 13 (0.8) | 2 (0.7) | <.001 |
Wound complications | 694 (0.5) | 662 (0.5) | 24 (1.3) | 8 (2.9) | <.001 |
Device complications | 28 (0.02) | 20 (0.02) | 1 (0.1) | 7 (2.5) | <.001 |
Other complications | 4689 (0.08) | 4575 (3.4) | 102 (5.8) | 12 (4.4) | <.001 |
Postoperative AKI and urinary complicationsa | 1999 (1.5) | 1704 (1.3) | 295 (16.4) | – | <.001 |
Associations between clinical outcomes and kidney disease
Postoperative complication | Postoperative AKI and urinary complicationsb | Length of stay | ||||||
---|---|---|---|---|---|---|---|---|
n (%) | OR (95% CI) | aOR (95%CI)a | n (%) | OR (95% CI) | aOR (95% CI)a | β ± SE | β ± SEa | |
Non-CKD (n = 134,751) | 12,011 (8.9) | Reference | Reference | 1,704 (1.3) | Reference | Reference | Reference | Reference |
CKD (n = 1,766) | 364 (20.6) |
2.66 (2.36–3.00)
|
1.36 (1.18–1.56)
| 295 (16.4) |
15.63 (13.53–18.07)
|
5.16 (4.32–6.17)
|
1.07 ± 0.11
|
0.25 ± 0.1
|
ESRD (n = 273) | 59 (21.6) |
2.83 (2.14–23.75)
| 1.35 (0.97–1.87) | – | – | – |
2.24 ± 0.41
|
0.98 ± 0.4
|
Associations between clinical outcomes and type of surgery
Surgical approach | Postoperative complication | Postoperative AKI and urinary complicationsb | Length of stay | ||||||
---|---|---|---|---|---|---|---|---|---|
n (%) | OR (95% CI) | aOR (95% CI)a | n (%) | OR (95% CI) | aOR (95% CI)a | β ± SE | β ± SEa | ||
All patients (N = 136,790) | Open | 8,665 (6.3) | Reference | Reference | 1,140 (0.8) | Reference | Reference | Reference | Reference |
Robot-assisted | 3,769 (2.8) |
0.55 (0.50–0.60)
|
0.55 (0.51–0.60)
| 859 (0.6) | 1.01 (0.90–1.13) | 1.09 (0.98–1.23) |
−0.77 ± 0.04
|
−0.75 ± 0.03
| |
Non-CKD (n = 134,751) | Open | 8,432 (6.3) | Reference | Reference | 987 (0.7) | Reference | Reference | Reference | Reference |
Robot-assisted | 3,579 (2.7) |
0.54 (0.49–0.59)
|
0.54 (0.50–0.60)
| 717 (0.5) | 0.98 (0.87–1.09) | 1.08 (0.96–1.22) |
−0.78 ± 0.04
|
−0.75 ± 0.03
| |
CKD n = 1,766) | Open | 197 (11.2) | Reference | Reference | 153 (8.7) | Reference | Reference | Reference | Reference |
Robot-assisted | 167 (9.5) |
0.66 (0.52–0.84)
|
0.65 (0.50–0.85)
| 142 (8.0) |
0.75 (0.57–0.98)
| 0.83 (0.62–1.12) |
−1.32 ± 0.24
|
−0.95 ± 0.18
| |
ESRD (n = 273) | Open | 36 (13.2) | Reference | Reference | – | – | Reference | Reference | |
Robot-assisted | 23 (8.4) | 0.61 (0.34–1.09) |
0.43 (0.21–0.91)
| −0.34 ± 0.84 | −0.66 ± 0.71 |