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Prostate cancer

Fee-for-Service Health Care Jeopardizes Robotic Prostate Surgery Patients

A “perverse disincentive” for hospitals that have invested in expensive technology for robotic surgery may be jeopardizing prostate cancer patients who seek out the procedure, according to a study led by Henry Ford Hospital researchers in Detroit and presented at the 2015 American Urological Association Annual Meeting in New Orleans.

A release from the hospital explains that the study, which compared complication rates in hospitals with low volumes of robot-assisted radical prostatectomies (RARPs) to institutions with high volumes of the procedure, suggested that current fee-for-service healthcare models might be to blame.

The release quotes Jesse Sammon, D.O., a researcher at Henry Ford’s Vattikuti Urology Institute and lead author of the study, as saying, “Patients pursue robotic surgery based on perceived benefit, including its minimally invasive nature and faster recovery time compared to conventional open surgery. But they fail to take into account the importance of hospital and surgeon experience on outcomes.”

Now the most common surgical method for treating prostate cancer in the U.S., RARP allows a surgeon to remove the diseased prostate by manipulating robotic arms holding undersized instruments through tiny incisions in the patient’s skin.

Besides avoiding the higher risk of infection and blood loss posed by open surgery, successful RARP reduces patient hospital stay and recovery time.

Researchers at Henry Ford Hospital, a pioneer in robotic surgery that has now performed more than 10,000 RARPs, saw a rapid increase in U.S. hospitals investing in the technology and performing the procedure during the past decade.

Building on earlier research that showed higher-volume hospitals had more success with the procedure than smaller institutions, the new study focused on all patients listed in the National Inpatient Sample (NIS) who underwent RARP between 2009 and 2011. The NIS collects and provides data on all patients discharged from a 20 percent sample of non-federal hospitals in the U.S.

Researchers also collected the number of RARPs performed at the hospitals where the patients were treated, categorized the hospitals according to that volume and recorded the complication rates for each.

They found:

  • The number of hospitals performing RARP remained stable over the study period – 802 in 2009, 792 in 2010 and 808 in 2011.
  • The overall complication rate after surgery was “significantly” related to the volume of RARPs performed at a hospital.
  • On average14.7 percent of patients treated at very-low volume institutions experienced complications while those treated at very-high volume institutions experienced a complication rate of 5.7 percent.
  • Patients treated at very-high volume hospitals were less than half as likely to experience a complication as those treated at very-low volume hospitals.