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Abstract

Objectives
To compare patterns of technological adoption of minimally invasive surgery for radical prostatectomy across the United States and England.

Data Sources
We examine radical prostatectomy in the United States and England between 2005 and 2017, using de-identified administrative claims data from the OptumLabs Data Warehouse in the United States and the Hospital Episodes Statistics in England.

Study Design
We conducted a longitudinal analysis of robotic, laparoscopic, and open surgery for radical prostatectomy. We compared the trends of adoption over time within and across countries. Next, we explored whether differential adoption patterns in the two health systems are associated with differences in volumes and patient characteristics. Finally, we explored the relationship between these adoption patterns and length of stay, 30-day readmission, and urology follow-up visits.

Data Collection
Open, laparoscopic, and robotic radical prostatectomies are identified using Office of Population Censuses and Surveys Classification of Interventions and Procedures (OPCS) codes in England and International Classification of Diseases ninth revision (ICD9), ICD10, and Current Procedural Terminology (CPT) codes in the United States.

Principal Findings
We identified 66,879 radical prostatectomies in England and 79,358 in the United States during 2005–2017. In both countries, open surgery dominates until 2009, where it is overtaken by minimally invasive surgery. The adoption of robotic surgery is faster in the United States. The adoption rates and, as a result, the observed centralization of volume, have been different across countries. In both countries, patients undergoing radical prostatectomies are older and have more comorbidities. Minimally invasive techniques show decreased length of stay and 30-day readmissions compared to open surgery. In the United States, robotic approaches were associated with lower length of stay and readmissions when compared to laparoscopic.

Conclusions
Robotic surgery has become the standard approach for radical proctectomy in the United States and England, showing decreased length of stay and in 30-day readmissions compared to open surgery. Adoption rates and specialization differ across countries, likely a product of differences in cost-containment efforts.

Publication Type:	Article
Additional Information:	This is the peer reviewed version of the following article: Maynou, L., Mehtsun, W. T., Serra-Sastre, V. & Papanicolas, I. (2021). Patterns of adoption of robotic radical prostatectomy in the United States and England. Health Services Research, 56(S3), pp. 1441-1461., which has been published in final form at https://doi.org/10.1111/1475-6773.13706. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Publisher Keywords:	Health Economics, Administrative Data Uses, Surgery, Health Care Organisations and Systems, Hospitals, Technology Adoption/Diffusion/Use
Subjects:	H Social Sciences > HB Economic Theory R Medicine > RC Internal medicine T Technology
Departments:	School of Policy & Global Affairs > Economics
SWORD Depositor:	Symplectic Administrator

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