Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy.

Autor: Logan CD; Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA., Mahenthiran AK; Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Siddiqui MR; Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., French DD; Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA., Hudnall MT; Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Patel HD; Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Murphy AB; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Halpern JA; Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Bentrem DJ; Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2023 Aug; Vol. 128 (2), pp. 375-384. Date of Electronic Publication: 2023 Apr 10.
DOI: 10.1002/jso.27274
Abstrakt: Background: Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP.
Study Design: The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort.
Results: Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP.
Conclusion: Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.
(© 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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