Surgeon and Hospital Level Variation in the Costs of Robot-Assisted Radical Prostatectomy.
Cole AP, Leow JJ, Chang SL, Chung BI, Meyer CP, Kibel AS, Menon M, Nguyen PL, Choueiri TK, Reznor G, Lipsitz SR, Sammon JD, Sun M, and Trinh QD. Surgeon and hospital-level variation in the costs of robot-assisted radical prostatectomy. J Urol 2016; 196(4):1090-1095.
The Journal of urology
PURPOSE: We assessed surgeon and hospital level variation in robot-assisted radical prostatectomy costs and predictors of high and low cost surgery.
MATERIALS AND METHODS: The study population consisted of a weighted sample of 291,015 men who underwent robot-assisted radical prostatectomy for prostate cancer by 667 surgeons at 197 U.S. hospitals from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 USD) in the Premier Hospital Database. High costs per robot-assisted radical prostatectomy were those above the 90th percentile and low costs were those below the 10th percentile.
RESULTS: Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group. Nearly a third of the variation in robot-assisted radical prostatectomy cost was attributable to hospital characteristics and more than a fifth was attributable to surgeon characteristics (R-squared 30.43% and 21.25%, respectively). High volume surgeons and hospitals (90th percentile or greater) had decreased odds of high cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105, 95% CI 0.02-0.46). The performance of robot-assisted radical prostatectomy at a high volume hospital was associated with increased odds of low cost robot-assisted radical prostatectomy (OR 839, 95% CI 122-greater than 999).
CONCLUSIONS: This study provides insight into the role of surgeons and hospitals in robot-assisted radical prostatectomy costs. Given the substantial variability, identifying and remedying the root cause of outlier costs may yield substantial benefits.
Medical Subject Headings
Aged; Hospital Costs; Hospitals, High-Volume; Humans; Length of Stay; Male; Middle Aged; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Surgeons; United States