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Comment & Response
April 2015

Faulty Analysis in Study of Robotic-Assisted Minimally Invasive Radical Prostatectomy—Reply

Author Affiliations
  • 1Department of Urology, University of California, San Diego, Heath System, San Diego
  • 2Urologic Cancer Unit, University of California, San Diego, Moores Cancer Center, La Jolla
  • 3Section of Surgery, VA San Diego Healthcare System, La Jolla, California
  • 4Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
JAMA Surg. 2015;150(4):372. doi:10.1001/jamasurg.2015.45

In Reply Thank you very much for the opportunity to reply to Mr Rosa and Dr Mohr. Their assertions are fundamentally flawed, rooted in mistaken assumptions, and unsupported by the peer-reviewed scientific data.

First, the data sets to which they refer—through imprecise and invalid extrapolations—are nonrepresentative, relatively small hospital populations drawn from voluntary quality improvement alliances1,2 and specific age groups (ie, Medicare).3 As such, they are susceptible to bias and unsuitable for inferring national trends in the diffusion of robotic surgery, particularly if a disproportionately large number of facilities participating in the quality improvement alliances own robotic surgery platforms. In contrast, we performed a cohort study of more than 400 000 patients using the much larger Nationwide Inpatient Sample, which the Agency for Healthcare Research and Quality designed to provide an appropriately weighted, representative sample of all US inpatient admissions.4

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