br CRP are scant and population based studies addressing this

207 CRP are scant and population-based studies addressing this BCI-121 topic are unavailable. To address this
210 population-based hospital inpatient database. Our analyses demonstrated several noteworthy
212 First, the proportion of robotically-assisted CRPs relative to open CRPs, was as high as
214 albeit in a non-significant fashion (p=0.5). Despite lack of statistical significance, such increase is r> 215 clinically meaningful and demonstrates that robotic surgery is becoming the most frequently used
216 approach for radical prostatectomy. Similar observations have been reported for patients with
217 clinically localized prostate cancer 9-11.
218 Second, robotically-assisted CRP patients less frequently experienced overall complications
221 open CRP patients. No differences in intraoperative, genitourinary, cardiac, pulmonary, vascular,
222 wound complications and bowel obstructions were recorded. Finally, also no differences in in-
224 Third, our study not only provides a crude comparison between intraoperative and
225 postoperative complications according to open vs. robotically-assisted CRPs, but also reports on
226 fully adjusted comparisons between the two approaches. After that adjustment, robotically-assisted
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230 the other complication endpoints, we were unable to perform adjusted analyses. Moreover, a
232 Last but not least, robotic surgery was associated with higher average total hospital charges (2483$,
234 Taken together, these observations derived from multivariable regression models,
235 corroborate the unadjusted comparisons that showed lower complication rates for robotically-
236 assisted CRP for four examined endpoints: overall complications, blood transfusions, miscellaneous
237 medical complications and miscellaneous surgical complications. This was evidenced by ORs of
239 adverse complication rates when CRP is performed with robotic-assistance. It is of utmost
240 importance to note that this finding originates from a population-based cohort and not from centers
241 of excellence data, where better intraoperative and postoperative complication profiles might be
242 expected relative to a population-based cohort.
243 Our findings related to total hospital charges demonstrated moderate increased charges for
244 robotic vs. open surgery. Specifically, the increase in total hospital charges for robotically-assisted
245 CRP relative to open CRP, was of $2483. Such increase in total hospital charges is of importance,
246 when osmoconformers is considered within a large cohort of patients, such as within the current analysis. For
247 example, when 500 patients treated with robotically-assisted radical prostatectomy instead of open
248 radical prostatectomy, the cumulative difference amounts to $1.2 million.
249 Last but not least, it is important to note absent or marginal perioperative mortality rates
250 respectively after robotically-assisted and open CRP. These numbers represent the ultimate safety
251 indicator. Moreover, their similarity provide the additional validation for lack of meaningful
252 differences between the two approaches.
253 In summary, our findings regarding intraoperative and postoperative complication rates,
254 LOS, mortality and total hospital charges between robotically-assisted and open CRP are indicative 12
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255 of decreased complication rates for four examined complication endpoints. Moreover, robotic
256 surgery resulted in a shorter LOS. Conversely, a moderate effect was noted on total hospital
257 charges. Finally, no differences in mortality rates were recorded. In consequence, our findings
258 validate the feasibility and safety of robotically-assisted CRP relative to open CRP, within a large
259 population-based cohort of contemporary North American patients. However, due to missing
260 prospective studies demonstrating a survival advantage for CRP relative to no local treatment in
261 mPCa patients, CRP, regardless of the used approach, should only be performed inside of clinical
262 trials and does not represent the current standard of care for mPCa patients.
264 retrospective analysis with all of its inherent limitations. Even though retrospective analyses usually
265 meet with criticism, it should be noted that no prospective trial, comparing complications between
266 robotically-assisted and open CRP, is ongoing, designed or even planned. The conduct of such trial