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%, Δ −5.6%, multivariable odds ratio (OR): 0.54), blood transfusions (1.2 vs. 6.3%, Δ −5.1%, OR: 0.21), and length of stay (LOS) > 2 days (10.6 vs. 28.7%, Δ −18.1%, OR: 0.32) were lower after RARP than after ORP (allp< 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%, Δ −6.4%, OR: 0.49; blood transfusion rates: 1.5 vs. 6.3%, Δ −4.8%, OR: 0.23; LOS > 2 days: 10.9 vs. 28.7%, Δ −17.8%, OR: 0.30). Conversely, RARP use resulted in higher total hospital charges (USD 43,690 vs. 36,840, Δ 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.
背景/目的：针对40-49岁（四旬期）年轻患者根治性前列腺切除术后的院内不良结局尚未得到专门研究。此外，该人群中机器人辅助根治性前列腺切除术（RARP）与开放根治性前列腺切除术（ORP）的比较尚未见报道。 方法：基于美国国家住院患者样本数据库（2009-2019年），对接受RARP或ORP的四旬期患者进行描述性分析、倾向评分匹配及多变量逻辑/泊松回归模型分析。 结果：在5426例四旬期患者中，分别有4083例（75.2%）和1343例（24.8%）接受了RARP和ORP。RARP占比从68.1%上升至84.5%（2009-2019年，年均百分比变化：+2.8%，p<0.001）。RARP术后院内不良结局均低于ORP组，具体表现为：总体并发症率（7.8% vs. 13.4%，差值-5.6%，多变量比值比：0.54）、输血率（1.2% vs. 6.3%，差值-5.1%，比值比：0.21）及住院时间>2天的比例（10.6% vs. 28.7%，差值-18.1%，比值比：0.32）均显著更低（所有p<0.001）。对ORP与RARP患者进行额外的一对一倾向评分匹配后，结果基本一致（总体并发症：7.0% vs. 13.4%，差值-6.4%，比值比：0.49；输血率：1.5% vs. 6.3%，差值-4.8%，比值比：0.23；住院时间>2天：10.9% vs. 28.7%，差值-17.8%，比值比：0.30）。相反，RARP导致更高的总住院费用（43,690美元 vs. 36,840美元，差值+6850美元，发生率比：1.18；p<0.001）。 结论：与ORP相比，四旬期患者接受RARP后表现出更有利的院内不良结局特征。这些优势被总住院费用虽小但显著的增加所抵消。
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