Commentary to “Robotic versus open pediatric ureteral reimplantation: Costs and complications from a nationwide sample journal of pediatric urology”

Abstract

Kurtz et al. [1] present a cautionary report comparing outcomes and costs associated with robot-assisted ureteral reimplantation (RALUR) after examining data contained within the Premier administrative database. The authors’ analysis demonstrates that RALUR is associated with a higher rate of complications and higher direct costs, compared to open ureteral reimplantation (OUR). Any study entirely predicated on a selfreported database with a geographic propensitydthe Premier database consists heavily of southern US small and mid-size hospitalsdcontains inherent bias, and they are manifest in this study. Still, in offering significant, though mostly intuitive, information related to cost and complications, this study reconfirms that RALUR is still a novel therapeutic modality, only recently being implemented at most institutions. As Kurtz et al. [1] report, 51% of the entire RALUR cohort analyzed for this study was accrued in the penultimate and final year of the study (2012e2013). And since the overall number of RALUR patients is very small (only 2.5% of the entire study population underwent RALUR), a comprehensive analysis is precluded. For example, although any new highly technical surgical procedure is associated with a steep learning curve, the small RALUR cohort precludes a power analysis of annual data trends to determine if increasing experience improves outcomes. The present analysis also cannot quantify the potential gains that are known to favor RALUR such as reduced