Advertisement

The Pros & Cons of Robotic Bladder Cancer Surgery

Robotic-assisted surgical removal of the bladder is becoming increasingly popular for treating bladder cancer, despite being more expensive than traditional surgery. Benefits of the robotic approach include smaller incisions and less blood loss for patients. In addition, surgeons have a better three-dimensional view and more freedom of wrist movement when compared with conventional laparoscopy. The procedure eliminates hand tremors, making tasks like suturing easier. However, robotic surgery for this patient group is fairly new. We’re only now beginning to gather larger, more comprehensive studies comparing outcomes of traditional open surgeries with robot-assisted procedures. [polldaddy poll=7559190] A New Analysis: Robotic Surgery In the March 30, 2012 issue of European Urology, my colleagues and I had a study  published that compared perioperative outcomes and costs of open robot-assisted laparoscopic radical cystectomy. Previous comparisons have been limited to reports from high-volume referral centers and have not made direct comparisons with regard to inpatient morbidity and mortality, lengths of stay, and costs. Using a national database of in-patient information from 1,050 hospitals in 44 states, our research team examined 1,444 traditional open surgeries and 224 robotic-assisted laparoscopic procedures in 2009. Robotic surgery for bladder cancer resulted in fewer deaths during hospitalization (0% vs 2.5%) and fewer in-patient complications (49.1% vs 63.8%) when compared with open surgery. It also reduced the need for intravenous nutrition after the procedure (6.4% vs 13.3%). Patients who underwent both types of surgery spent about 8 days in the hospital. Costs of Robot-Assisted Cystectomy The costs for robot-assisted laparoscopic radical cystectomy were significantly higher, amounting to nearly $3,800 more than traditional open surgery. This may be due to longer...

Hospital Volume & Mortality: Trends in High-Risk Surgery

A growing number of studies have reported inverse relationships between hospital volume and surgical mortality, with lower mortality seen in higher-volume institutions. There have been numerous efforts to concentrate selected operations at high-volume hospitals. The Leapfrog Group, a consortium of large corporations and public agencies that purchase healthcare for their employees, has been among the most prominent advocates of volume-based referrals. Private payers and professional organizations have also established minimum-volume standards as part of Centers of Excellence accreditation programs for a variety of operations. “Despite these efforts, little is known if they have altered referral patterns for high-risk surgery,” says Jonathan F. Finks, MD. Throughout the country, more and more surgical patients are being treated at high-volume hospitals, but the net effects on operative mortality can be difficult to predict. Dr. Finks says, “for example, hospital volume of a few high-risk cancer procedures, such as pancreatectomy, appears to be a strong predictor of operative risk. At the same time, relationships between surgical volume and outcome are much weaker for most operations.” “Some strategies that appear to be of particular benefit include use of operating-room checklists, outcomes measurement and feedback programs, and national and regional collaborative quality-improvement initiatives.” In a study published in the June 2, 2011 New England Journal of Medicine, Dr. Finks and colleagues at the University of Michigan used data from national Medicare claims to evaluate trends in the use of high-volume hospitals for major cancer resections and cardiovascular surgery. The investigators identified patients (aged 65 to 99) who underwent one of the following cancer and cardiovascular operations from 1999 through 2008: 1) esophagectomy, 2) pancreatectomy, 3) lung...
[ HIDE/SHOW ]