Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Charles D. Logan; Ashorne K. Mahenthiran; Mohammad R. Siddiqui; Dustin D. French; Matthew T. Hudnall; Hiten D. Patel; Adam B. Murphy; Joshua A. Halpern; David J. Bentrem

doi:10.1002/jso.27274

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Charles D. Logan^*, Ashorne K. Mahenthiran, Mohammad R. Siddiqui, Dustin D. French, Matthew T. Hudnall, Hiten D. Patel, Adam B. Murphy, Joshua A. Halpern, David J. Bentrem

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. Study Design: The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Results: Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49–0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Conclusion: Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

Original language	English (US)
Pages (from-to)	375-384
Number of pages	10
Journal	Journal of surgical oncology
Volume	128
Issue number	2
DOIs	https://doi.org/10.1002/jso.27274
State	Published - Aug 2023

Funding

The data used in the study are derived from a de‐identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The content of this abstract is original research using the National Cancer Database (NCDB) and is not a clinical trial. CDL is supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (T37MD014248). ABM is supported by a grant from the National Cancer Institute (R01CA249973‐03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The content of this abstract is original research using the National Cancer Database (NCDB) and is not a clinical trial. CDL is supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (T37MD014248). ABM is supported by a grant from the National Cancer Institute (R01CA249973-03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

Medicaid
healthcare disparities
national cancer database
prostate cancer
robot-assisted radical prostatectomy

ASJC Scopus subject areas

Oncology
Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/jso.27274

Cite this

@article{dae2e61c66a74838926dbc4f586cd62e,

title = "Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy",

abstract = "Background: Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. Study Design: The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Results: Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49–0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Conclusion: Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.",

keywords = "Medicaid, healthcare disparities, national cancer database, prostate cancer, robot-assisted radical prostatectomy",

author = "Logan, {Charles D.} and Mahenthiran, {Ashorne K.} and Siddiqui, {Mohammad R.} and French, {Dustin D.} and Hudnall, {Matthew T.} and Patel, {Hiten D.} and Murphy, {Adam B.} and Halpern, {Joshua A.} and Bentrem, {David J.}",

note = "Funding Information: The data used in the study are derived from a de‐identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The content of this abstract is original research using the National Cancer Database (NCDB) and is not a clinical trial. CDL is supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (T37MD014248). ABM is supported by a grant from the National Cancer Institute (R01CA249973‐03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The content of this abstract is original research using the National Cancer Database (NCDB) and is not a clinical trial. CDL is supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (T37MD014248). ABM is supported by a grant from the National Cancer Institute (R01CA249973-03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.",

year = "2023",

month = aug,

doi = "10.1002/jso.27274",

language = "English (US)",

volume = "128",

pages = "375--384",

journal = "Journal of surgical oncology",

issn = "0022-4790",

publisher = "Wiley-Liss Inc.",

number = "2",

}

TY - JOUR

T1 - Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

AU - Logan, Charles D.

AU - Mahenthiran, Ashorne K.

AU - Siddiqui, Mohammad R.

AU - French, Dustin D.

AU - Hudnall, Matthew T.

AU - Patel, Hiten D.

AU - Murphy, Adam B.

AU - Halpern, Joshua A.

AU - Bentrem, David J.

N1 - Funding Information: The data used in the study are derived from a de‐identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The content of this abstract is original research using the National Cancer Database (NCDB) and is not a clinical trial. CDL is supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (T37MD014248). ABM is supported by a grant from the National Cancer Institute (R01CA249973‐03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The content of this abstract is original research using the National Cancer Database (NCDB) and is not a clinical trial. CDL is supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (T37MD014248). ABM is supported by a grant from the National Cancer Institute (R01CA249973-03). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2023 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.

PY - 2023/8

Y1 - 2023/8

N2 - Background: Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. Study Design: The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Results: Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49–0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Conclusion: Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

AB - Background: Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. Study Design: The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Results: Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49–0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Conclusion: Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

KW - Medicaid

KW - healthcare disparities

KW - national cancer database

KW - prostate cancer

KW - robot-assisted radical prostatectomy

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DO - 10.1002/jso.27274

M3 - Article

C2 - 37036165

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SN - 0022-4790

VL - 128

SP - 375

EP - 384

JO - Journal of surgical oncology

JF - Journal of surgical oncology

IS - 2

ER -

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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