OBJECTIVES: Since the first robot-assisted laparoscopic prostatectomy (RALP) in 2000, the technique has quickly become the standard of care over traditional open surgery and pure laparoscopic surgery. Patient outcomes were analyzed to better understand the benefits of RALP compared to its predecessors.

METHODS: De-identified patient records were extracted from Cerner Real World Data (CRWD), a US electronic health record database. Prostate cancer patients who underwent robotic and non-robotic radical prostatectomy between April 2012 and January 2017 were identified via Current Procedural Terminology (CPT), SNOMED, and ICD-10-PCS codes. Diagnosis of urinary tract infection, urinary incontinence, urethral stricture, and erectile dysfunction were assessed up to three months post-index using ICD-10-CM and relevant medications. Five year mortality, 90 day readmissions, and length of stay were also evaluated. Multivariate analyses were conducted using logistic regression to report odds ratios (OR).

RESULTS: A total of 1,268 patients underwent non-robotic radical prostatectomy, while 232 underwent RALP. The median age in both groups was 66 years. Compared to non-robotic radical prostatectomy, survival odds after 5 years were better in the RALP group by a factor of 1.2 (p = 0.003). There were no other statistically significant differences (p < 0.05) for any other outcomes of interest.

CONCLUSIONS: Although there was an improvement in 5 year mortality for patients who received robotic-assisted prostatectomy, there was no evidence that it improved any other measured outcome or reduced any measured complication. The inability to detect statistically significant differences in other outcomes may be due to RALPs being coded incorrectly, thus leading to a smaller than anticipated sample size. The results of this study suggest that RALPs may have survival benefits. Therefore, further analysis is warranted to determine the extent of RALPs effect on patient survival, particularly utilizing a larger dataset to increase power and identify better outcomes.