Adverse In-Hospital Outcomes Following Robot-Assisted vs. Open Radical Prostatectomy in Quadragenarians

Background/Objectives: Adverse in-hospital outcomes at radical prostatectomy have not been specifically addressed in young patients aged 40-49 years (quadragenarians). Additionally, no comparison between robot-assisted (RARP) vs. open radical prostatectomy (ORP) has been reported in this population. Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic/Poisson regression models addressed quadragenarians undergoing RARP or ORP within the National Inpatient Sample (2009-2019). Results: Of 5426 quadragenarians, 4083 (75.2%) and 1343 (24.8%) underwent RARP and ORP, respectively. The proportion of RARP increased from 68.1 to 84.5% (2009-2019, EAPC: +2.8%, p < 0.001). Adverse in-hospital outcomes after RARP were invariably lower than those after ORP. Specifically, the rates of overall complications (7.8 vs. 13.4%, Delta -5.6%, multivariable odds ratio (OR): 0.54), blood transfusions (1.2 vs. 6.3%, Delta -5.1%, OR: 0.21), and length of stay (LOS) > 2 days (10.6 vs. 28.7%, Delta -18.1%, OR: 0.32) were lower after RARP than after ORP (all p < 0.001). After additional one-to-one PSM between ORP and RARP patients, virtually the same results were reported (overall complications: 7.0 vs. 13.4%, Delta -6.4%, OR: 0.49; blood transfusion rates: 1.5 vs. 6.3%, Delta -4.8%, OR: 0.23; LOS > 2 days: 10.9 vs. 28.7%, Delta -17.8%, OR: 0.30). Conversely, RARP use resulted in higher total hospital charges (USD 43,690 vs. 36,840, Delta USD +6850, IRR: 1.18; p < 0.001). Conclusions: Quadragenarians exhibited a more favorable adverse in-hospital outcome profile after RARP vs. ORP. These advantages are offset by a small, albeit significant, increase in total hospital charges.