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Robots drive the German radical prostatectomy market: a total population analysis from 2006 to 2013
- Source :
- Prostate cancer and prostatic diseases. 19(4)
- Publication Year :
- 2016
-
Abstract
- To assess trends in the distribution of patients for radical prostatectomy in Germany from 2006 to 2013 and the impact of robotic surgery on annual caseloads. We hypothesized that the advent of robotics and the establishment of certified prostate cancer centers caused centralization in the German radical prostatectomy market.Using remote data processing we analyzed the nationwide German billing data from 2006 to 2013. We supplemented this database with additional hospital characteristics like the prostate cancer center certification status. Inclusion criteria were a prostate cancer diagnosis combined with radical prostatectomy. Hospitals with certification or a surgical robot in 2009 were defined as 'early' group. Linear covariant-analytic models were applied to describe trends over time.Annual radical prostatectomy numbers declined from 28 374 (2006) to 21 850 (2013). High-volume hospitals (⩾100 cases) decreased from 87 (22.0%) in 2006 to 43 (10.4%) in 2013. Low-volume hospitals (50 cases) increased from 193 (48.7%) to 280 (67.4%). Mean radical prostatectomy caseloads of hospitals with early vs without certification declined from 155 to 130 vs 77 to 39 (P=0.021 for trend comparison). Early robotic hospitals maintained their volume200 cases per year contrary to the overall trend (P0.001 for trend comparison). A multivariate model for caseload numbers of 2013 indicated a robotic system to be the most important factor for higher caseloads (multiplication factor 7.3; 95% confidence interval: 6.6-8.0). A prostate cancer center certification (multiplication factor 1.6; 95% confidence interval: 1.50-1.59) had a much smaller impact.We found decentralization of radical prostatectomy in Germany. The driving force for this development might consist in the overall decline of radical prostatectomy numbers. The most important factor for achieving higher caseloads was the presence of a robotic system. In order to optimize outcomes of radical prostatectomy additional health policy measures might be necessary.
- Subjects :
- Oncology
Male
Cancer Research
medicine.medical_specialty
Urology
medicine.medical_treatment
030232 urology & nephrology
Prostatitis
Total population
German
03 medical and health sciences
Prostate cancer
0302 clinical medicine
Robotic Surgical Procedures
Internal medicine
Germany
medicine
Humans
Aged
Prostatectomy
business.industry
Prostate
Prostatic Neoplasms
Robotics
Middle Aged
medicine.disease
language.human_language
Prostate-specific antigen
030220 oncology & carcinogenesis
language
Benign prostatic hyperplasia (BPH)
business
Subjects
Details
- ISSN :
- 14765608
- Volume :
- 19
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Prostate cancer and prostatic diseases
- Accession number :
- edsair.doi.dedup.....b32350546880e2bc82ece0a887902e20