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Frank S Siringo, Timothy Wen, Christopher Diebert, Benjamin Spencer; Positioning-Related Ocular Complications of Minimally-Invasive Radical Prostatectomies. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5574.
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To characterize positioning-related ocular complications of robotic-assisted radical prostatectomy, (RARP), compared to open radical prostatectomy (ORP), and laparascopic-assisted radical prostatectomy (LRP).
A retrospective study using 2008-09 discharge information data in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Patients diagnosed with prostate cancer undergoing ORP, LRP, or RARP were included. Outcome measures included a positioning-related complication, increased inpatient costs, prolonged length of stay, and in-hospital mortality. Chi-square, Fisher’s exact tests and multivariable logistic regression models compared groups and assessed associations between covariates and outcomes of interest.
175,699 patients diagnosed with prostate cancer underwent radical prostatectomy in 2008-09; some 61,656 (35.1%) had RARP, 2,682 (1.5%) LRP, and 111,361 (63.4%) ORP. A total of 698 (0.4%) patients experienced a positioning complication. Ocular complications were most common, (51.1%), with non-significant differences in rates of 0.22% in ORP/LRP, vs 0.17% in RARP (p<0.110). Visually threatening ocular complication rates (retinal vascular occlusion, angle closure glaucoma, ischemic optic neuropathy, unilateral blindness) for ORP/LRP and RARP were 0.15% and 0.07%, respectively. The only significant hospital covariate was high annual RP case volume (>101 procedures), and it was protective (OR = 0.45, 95% CI: 0.27, 0.72, p-value = 0.0011).
This study is one of the first to assess positioning related ocular complications in a national population-based database. Despite prolonged steep trendelenburg positioning during RARP, vision-threatening ocular complications were more common in ORP/LRP. The primary limitation of the study was the use of administrative claims data, which lack detailed clinical information. However, the large national sample size increases the generalizability of our results.
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