Presentation Authors: Olamide Omidele*, New York, NY, Mark Finkelstein, Khawaja Bilal, Michael Palese, New York , NY
Introduction: Radical Prostatectomy (RP) is the gold-standard surgical treatment for men diagnosed with organ-confined prostate cancer. This study assesses differences amongst patients undergoing RP based on academic hospital teaching status.
Methods: Data was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2006 to 2015. ICD-9-CM procedural code 60.5 was used to identify all radical prostatectomies conducted in New York State (NYS) during the study period. All hospitals were categorized into major, minor, and non-teaching hospital status as defined by the American Hospital Association database. Patient level characteristics and hospital level characteristics were collected and compared amongst groups.
Results: There were 25,813 RP conducted at major-teaching hospitals, 13,002 at minor-teaching hospitals, and 1,717 at non-teaching hospitals. Major teaching hospitals had more physicians, cases, and hospital beds (p < .001). Non-teaching hospitals saw a larger proportion of white patients (85%) than minor- (72%) and major-teaching hospitals (70%). 50% of the major-teaching hospitals were high-volume centers compared to just 25% of minor-teaching and 0% of non-teaching (p < .001). Teaching hospitals conducted more minimally-invasive (MIS) RPs than non-teaching hospitals, had lower length of stay , and less mortality at 360 days than non-teaching hospitals (p < .001). Positive predictors of RP at major teaching hospitals included higher Charlson Comorbidity Index (p < .001), Asian race (p < .001), and black race (0.003). Negative predictors of RP at major teaching hospitals included Medicaid status, Medicare status, and out-of-pocket payment (p < .001).
Conclusions: The study shows significant differences in patient characteristics and outcomes based on hospital teaching status. These results suggests that major teaching hospitals in NYS conduct a majority of the RP, use more MIS techniques, and see a more diverse, complex patient population without sacrificing outcomes.