New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) ...is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter.
This study aimed to determine if patient satisfaction differs between video and in-person visits.
In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre-COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively.
We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate PE 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE -2.05; 95% CI -2.66 to -1.22), female gender (PE -0.73; 95% CI -0.96 to -0.50), and new visit type (PE -0.75; 95% CI -1.00 to -0.49) were associated with lower patient satisfaction.
Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The PLCO trial generated data that argue against PSA screening. However, participants in the control group also reported being screened. An analysis of health questionnaires suggests that more than ...80% of controls had been tested within the previous 3 years.
To the Editor:
In March, the Centers for Medicare and Medicaid Services temporarily suspended the development of a proposed “Non-Recommended Prostate-Specific Antigen (PSA)–Based Screening” measure that would discourage PSA screening in all men. The U.S. Preventive Services Task Force (USPSTF) is currently in the process of updating its recommendations for prostate-cancer screening. The decisions made by these two organizations are likely to determine the fate of PSA screening in the United States.
Much of the controversy surrounding screening revolves around the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, which randomly assigned men to annual prostate-cancer screening or usual . . .
Abstract Introduction Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer (PCa). Its adoption has been driven by market forces and patient preference, and debate continues ...regarding whether it offers improved outcomes to justify higher cost relative to open surgery. We examined comparative effectiveness of robot assisted (RARP) versus open radical prostatectomy (ORP) in cancer control and survival in a nationally representative population. Materials and Methods Population based observational cohort study of PCa patients undergoing RARP and ORP during 2003-2012 captured in Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Propensity score matching and time to event analysis was used to compare all-cause mortality, prostate cancer-specific mortality and use of additional treatment following surgery. Results 6,430 RARP and 9,161 ORP performed during 2003-2012 were identified. RARP increased in use from 13.6% to 72.6% in 2003-2004 to 72.6% in 2011-2012. After median follow-up of 6.5 years (IQR 5.2-7.9), RARP was associated with equivalent risk of all-cause mortality (Hazard Ratio HR 0.85, 0.72-1.01) and similar cancer-specific mortality (HR 0.85, 0.50-1.43) versus ORP. RARP was also associated with less use of additional treatment (HR 0.78, 0. 70-0.86). Conclusions RARP has comparable intermediate cancer control, as evidenced by less use of additional postoperative cancer therapies and equivalent cancer-specific and overall survival. Longer-term follow-up is needed to assess for differences in PCa-specific survival, which was similar during intermediate follow-up. Our findings have significant quality and cost implications and provide reassurance regarding the adoption of more expensive technology in absence of randomized controlled trials.
The European Association of Urology and American Urological Association offer differing recommendations on the prostate biopsy approach to use to minimize infection. Current level 1 evidence ...demonstrates no difference in infectious complications.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This Viewpoint analyzes Surveillance, Epidemiology, and End Results–Medicare linked data from 2010 to 2019 using a previously established method to examine contemporary radical prostatectomy outcomes.
Robotic-assisted retroperitoneal lymph node dissection (R-RPLND) is an emerging surgical option for testicular cancer with less morbidity than open RPLND. We outline the operative technique used at ...our center and review contemporary evidence in the advancement of R-RPLND.
R-RPLND is being applied effectively beyond clinical stage I testicular cancer to treat low-volume, clinical stage II disease in both the primary and postchemotherapy setting. Compared with the open approach, R-RPLND offers shorter hospitalization and less blood loss with comparably low complications and oncologic control.
With ongoing adoption and optimization of R-RPLND, future studies will assess long-term oncologic outcomes and disseminate R-RPLND in the treatment of testicular cancer.
To assess the outcomes, total healthcare utilization, and cost savings for same-day discharge (SDD) vs inpatient robotic-assisted partial nephrectomy (RAPN) and robotic-assisted radical nephrectomy ...(RARN).
We compared 146 RAPNs and 65 RARNs consecutively performed as SDD (RAPN=21, RARN=9) vs inpatient (RAPN=125, RARN=56) from April 2015 to May 2023 at two academic medical centers. We collected baseline demographics, perioperative characteristics, and 30-day complications. We applied the Time-Driven Activity-Based Costing analysis to compare total costs of RAPN and PARN throughout the cycle of care, including inpatient vs SDD.
Baseline demographics and comorbidities were similar between patients undergoing inpatient vs SDD RAPN and RARN. One Clavien-Dindo grade II complication (3.3%) requiring readmission due to wound infection for antibiotics occurred after SDD RAPN; no complications occurred after SDD RARN. Two unscheduled office or emergency department visits (6.7%) occurred after SDD RAPN for surgical-site infection and urinary retention. SDD vs inpatient RAPN and RARN demonstrated a $3091 (18%) and $4003 (25%) overall cost reduction, respectively.
SDD RAPN and RARN result in cost savings of 18%-25% without a difference in complications, and thereby improves value-based care for appropriately selected patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To ...determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MAIN OUTCOME MEASURES We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control. RESULTS Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval CI, 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35). CONCLUSION Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.
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