OBJECTIVES

To examine temporal trends of outpatient radical prostatectomy for prostate cancer in the U.S. after the Centers for Medicare & Medicaid Services removed laparoscopic radical prostatectomy from the inpatient-only procedure list, effective January 2018

METHODS

A retrospective cohort analysis was performed of adult males who underwent elective radical prostatectomy for prostate cancer from January 1, 2014 to June 30, 2019 in the Premier Hospital Perspective Database®. Patients with missing or extreme values of total cost and/or operating room/ (OR) time were excluded from the analysis. The proportion of outpatient surgery was calculated quarterly.

RESULTS

The study included 62,259 patients: 88.6% robotic-assisted radical prostatectomy/ (RARP), 10.4% open radical prostatectomy/ (ORP) and only 1.1% laparoscopic radical prostatectomy/ (LRP). From 2014 to 2017, the quarterly proportions of outpatient prostatectomy were stable and were less than 5% in the fourth quarter (Q4) of 2017. The proportions of outpatient prostatectomy increased after 2018 and reached to 36.9% in the second quarter (Q2) of 2019. This increase was primarily observed in patients who underwent RARP.

Among RARP patients, the proportion of outpatient procedures increased from 5.35% in 2017 Q4 to 39.5% in 2019 Q2. For ORP, outpatient surgery remained less than 5.4% up to 2019 Q2. The outpatient migration trend was observed not only among patients primarily covered by Medicare (increasing from 4.7% in 2017 Q4 to 43.7% in 2019 Q2) but also among patients with commercial insurance (increasing from 5.0% in 2017 Q4 to 33.6% in 2019 Q2).

CONCLUSIONS

Since January 2018, a significant shift from the inpatient to outpatient setting for radical prostatectomy was observed mainly among patients undergoing RARP. Both patients with Medicare and with commercial insurance coverage experienced the shift to outpatient prostatectomy. Further studies are needed to investigate the safety, effectiveness and cost-effectiveness of outpatient migration.