1226 PERIOPERATIVE COST COMPARISON OF ROBOTIC AND OPEN RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease I1 Apr 20121226 PERIOPERATIVE COST COMPARISON OF ROBOTIC AND OPEN RADICAL CYSTECTOMY FOR BLADDER CANCER Stephen F. Kappa, Todd M. Morgan, R. Lawrence Van Horn, Sam S. Chang, Peter E. Clark, Michael S. Cookson, Rodney Davis, David F. Penson, Joseph A. Smith, Chaochen You, and Daniel A. Barocas Stephen F. KappaStephen F. Kappa Nashville, TN More articles by this author , Todd M. MorganTodd M. Morgan Nashville, TN More articles by this author , R. Lawrence Van HornR. Lawrence Van Horn Nashville, TN More articles by this author , Sam S. ChangSam S. Chang Nashville, TN More articles by this author , Peter E. ClarkPeter E. Clark Nashville, TN More articles by this author , Michael S. CooksonMichael S. Cookson Nashville, TN More articles by this author , Rodney DavisRodney Davis Nashville, TN More articles by this author , David F. PensonDavid F. Penson Nashville, TN More articles by this author , Joseph A. SmithJoseph A. Smith Nashville, TN More articles by this author , Chaochen YouChaochen You Nashville, TN More articles by this author , and Daniel A. BarocasDaniel A. Barocas Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1516AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have reached conflicting conclusions comparing the costs of robotic-assisted radical cystectomy (RRC) versus open radical cystectomy (ORC) for bladder cancer. Beyond the fixed cost and maintenance fee associated with the robot itself, we sought to determine if there were operative, postoperative, or total perioperative cost differences between the robotic and open approaches. METHODS Using a hospital billing database at a single tertiary care center, we compared the costs associated with RRC versus ORC for bladder cancer patients from December 2007 to May 2011. Demographics, clinical characteristics, and postoperative complications were compared between groups. Operative, postoperative, and total perioperative costs were calculated for each group and converted to percentage differences given the proprietary nature of internal billing data. RESULTS Eighty-six (86) patients underwent RRC while 319 underwent ORC. Preoperatively, RRC patients were disproportionately male (p<0.001), had a significantly lower mean body mass index (p=0.005), and had less severe disease (clinical stage T2 or higher) (p=0.036) compared to ORC patients. There were no significant differences in comorbidities (p=0.22). ORC was associated with 13.4% lower perioperative costs compared to RRC (p<0.001). Within the perioperative period, open surgery was associated with 20.4% lower operative costs (p<0.001), but robotic surgery was associated with 21.6% lower postoperative-90 day costs (p<0.001). CONCLUSIONS RRC is associated with significantly higher total perioperative costs than ORC. This difference largely reflects the increased variable costs associated with robotic surgery, such as longer operative time and greater disposable equipment use. However, the 90-day postoperative period for robotic surgery is associated with lower costs compared to open surgery, reflecting lower downstream utilization of healthcare resources, such as emergency care. This study does not account for the selection bias of healthier patients with less severe disease for robotic surgery, nor the potential advantages associated with minimally-invasive surgery, such as more rapid return to baseline functional status. Nevertheless, this study suggests that costs for RRC significantly exceed those of ORC for bladder cancer, although postoperative cost savings related to robotic surgery do exist. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e496 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen F. Kappa Nashville, TN More articles by this author Todd M. Morgan Nashville, TN More articles by this author R. Lawrence Van Horn Nashville, TN More articles by this author Sam S. Chang Nashville, TN More articles by this author Peter E. Clark Nashville, TN More articles by this author Michael S. Cookson Nashville, TN More articles by this author Rodney Davis Nashville, TN More articles by this author David F. Penson Nashville, TN More articles by this author Joseph A. Smith Nashville, TN More articles by this author Chaochen You Nashville, TN More articles by this author Daniel A. Barocas Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...