TY - JOUR
T1 - The Association of Robot-assisted Versus Pure Laparoscopic Radical Nephrectomy with Perioperative Outcomes and Hospital Costs
AU - Gershman, Boris
AU - Bukavina, Laura
AU - Chen, Zhengyi
AU - Konety, Badrinath
AU - Schumache, Fredrick
AU - Li, Li
AU - Kutikov, Alexander
AU - Smaldone, Marc
AU - Abouassaly, Robert
AU - Kim, Simon P.
N1 - Publisher Copyright:
© 2018 European Association of Urology
PY - 2020/3/15
Y1 - 2020/3/15
N2 - Background: Although robot assistance can facilitate the advantages of minimally invasive surgery, it is unclear whether it offers benefits in settings in which laparoscopic surgery has been established as the standard of care. Objective: To examine the comparative effectiveness of robot-assisted laparoscopic radical nephrectomy (RALRN) and laparoscopic radical nephrectomy (LRN) using a nationwide data set. Design, setting, and participants: 8316 adults who underwent RALRN or LRN for non-urothelial renal cancer from the Nationwide Inpatient Sample from 2010 to 2013. Intervention: RALRN and LRN. Outcome measurements and statistical analysis: The associations of surgical approach with perioperative outcomes and total hospital costs were evaluated using multivariable logistic regression. Results and limitations: Over the study period, utilization of RALRN increased from 46% to 69%. Compared to LRN, RALRN was associated with lower rates of intraoperative (0.9% vs 1.8%; p < 0.001) and postoperative complications (20.4% vs 27.2%; p < 0.001), but there were no differences in perioperative blood transfusion (5.6% vs 6.2%; p = 0.27) and prolonged hospitalization (7.2% vs 7.1%; p = 0.81). RALRN was also significantly associated with higher total hospital costs (median $16 207 vs $15 037; p < 0.001). In multivariable analyses, RALRN remained independently associated with a lower risk of intraoperative (odds ratio [OR] 0.50; p = 0.001) and postoperative complications (OR 0.72; p < 0.001) but not perioperative blood transfusion (OR 1.10; p = 0.34), and with a higher risk of prolonged hospitalization (OR 1.29; p = 0.007) and higher mean total hospital costs (+$1468; p < 0.001). There was no effect modification by hospital volume. Conclusions: Although RALRN was independently associated with a reduction in perioperative complications compared to LRN, it was associated with prolonged hospitalization and higher total hospital costs. These relationships must be interpreted in light of potential differences in case mix. Patient summary: Although robot-assisted laparoscopic radical nephrectomy was independently associated with a reduction in perioperative complications compared to laparoscopic radical nephrectomy, it was associated with prolonged hospitalization and higher total hospital costs. Although robot-assisted laparascopic radical nephrectomy (RALRN) was independently associated with reductions in perioperative complications compared to pure LRN, it was associated with prolonged hospitalization and higher total hospital costs. These relationships must be interpreted in light of potential differences in case mix, but use of RALRN may result in greater scrutiny of the utilization of robotic platforms among patients undergoing nephrectomy for kidney cancer by third-party payers and policy-makers.
AB - Background: Although robot assistance can facilitate the advantages of minimally invasive surgery, it is unclear whether it offers benefits in settings in which laparoscopic surgery has been established as the standard of care. Objective: To examine the comparative effectiveness of robot-assisted laparoscopic radical nephrectomy (RALRN) and laparoscopic radical nephrectomy (LRN) using a nationwide data set. Design, setting, and participants: 8316 adults who underwent RALRN or LRN for non-urothelial renal cancer from the Nationwide Inpatient Sample from 2010 to 2013. Intervention: RALRN and LRN. Outcome measurements and statistical analysis: The associations of surgical approach with perioperative outcomes and total hospital costs were evaluated using multivariable logistic regression. Results and limitations: Over the study period, utilization of RALRN increased from 46% to 69%. Compared to LRN, RALRN was associated with lower rates of intraoperative (0.9% vs 1.8%; p < 0.001) and postoperative complications (20.4% vs 27.2%; p < 0.001), but there were no differences in perioperative blood transfusion (5.6% vs 6.2%; p = 0.27) and prolonged hospitalization (7.2% vs 7.1%; p = 0.81). RALRN was also significantly associated with higher total hospital costs (median $16 207 vs $15 037; p < 0.001). In multivariable analyses, RALRN remained independently associated with a lower risk of intraoperative (odds ratio [OR] 0.50; p = 0.001) and postoperative complications (OR 0.72; p < 0.001) but not perioperative blood transfusion (OR 1.10; p = 0.34), and with a higher risk of prolonged hospitalization (OR 1.29; p = 0.007) and higher mean total hospital costs (+$1468; p < 0.001). There was no effect modification by hospital volume. Conclusions: Although RALRN was independently associated with a reduction in perioperative complications compared to LRN, it was associated with prolonged hospitalization and higher total hospital costs. These relationships must be interpreted in light of potential differences in case mix. Patient summary: Although robot-assisted laparoscopic radical nephrectomy was independently associated with a reduction in perioperative complications compared to laparoscopic radical nephrectomy, it was associated with prolonged hospitalization and higher total hospital costs. Although robot-assisted laparascopic radical nephrectomy (RALRN) was independently associated with reductions in perioperative complications compared to pure LRN, it was associated with prolonged hospitalization and higher total hospital costs. These relationships must be interpreted in light of potential differences in case mix, but use of RALRN may result in greater scrutiny of the utilization of robotic platforms among patients undergoing nephrectomy for kidney cancer by third-party payers and policy-makers.
KW - Costs
KW - Laparoscopic
KW - Perioperative outcomes
KW - Radical nephrectomy
KW - Robotic
UR - http://www.scopus.com/inward/record.url?scp=85055100514&partnerID=8YFLogxK
U2 - 10.1016/j.euf.2018.10.004
DO - 10.1016/j.euf.2018.10.004
M3 - Article
C2 - 30361146
AN - SCOPUS:85055100514
SN - 2405-4569
VL - 6
SP - 305
EP - 312
JO - European Urology Focus
JF - European Urology Focus
IS - 2
ER -