Background: To test contemporary rates and predictors of open conversion at minimally invasive (laparoscopic or robotic) radical prostatectomy (MIRP). Materials and Methods: Within the National Inpatient Sample database (2008-2015), we identified all MIRP patients and patients who underwent open conversion at MIRP. First, estimated annual percentage changes (EAPCs) tested temporal trends of open conversion. Second, multivariable logistic regression models predicted open conversion at MIRP. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results: Of 57,078 MIRP patients, 368 (0.6%) underwent open conversion. The rates of open conversion decreased over time (from 1.80% to 0.38%; EAPC: -26.0%; p = 0.003). In multivariable logistic regression models predicting open conversion, patient obesity (odds ratio [OR]: 2.10; p < 0.001), frailty (OR: 1.45; p = 0.005), and Charlson comorbidity index (CCI) ≥2 (OR: 1.57; p = 0.03) achieved independent predictor status. Moreover, compared with high-volume hospitals, medium-volume (OR: 2.03; p < 0.001) and low-volume hospitals (OR: 3.86; p < 0.001) were associated with higher rates of open conversion. Last but not least, when the interaction between the number of patient risk factors (obesity and/or frailty and/or CCI ≥2) and hospital volume was tested, a dose-response effect was observed. Specifically, the rates of open conversion ranged from 0.3% (patients with zero risk factors treated at high-volume hospitals) to 2.2% (patients with two to three risk factors treated at low-volume hospitals). Conclusion: Overall contemporary (2008-2015) rate of open conversion at MIRP was 0.6% and it was strongly associated with patient obesity, frailty, CCI ≥2, and hospital surgical volume. In consequence, these parameters should be taken into account during preoperative patients counseling, as well as in clinical and administrative decision making.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Quebec Canada

Department of Oncology and Hemato Oncology University of Milan Milan Italy

Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology European Institute of Oncology IRCCS Milan Italy

Department of Urology IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico University of Milan Milan Italy

Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Department of Urology University of Texas Southwestern Dallas Texas

Department of Urology University of Turin San Luigi Gonzaga Hospital Turin Italy

Departments of Urology Weill Cornell Medical College New York New York

Division of Experimental Oncology Department of Urology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Martini Klinik University Medical Center Hamburg Eppendorf Hamburg Germany

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