Hospital Ownership, Geographic Region, Patient Age, Comorbidities, and Insurance Status Appear to Influence Patient Selection Robot-Assisted Ureteral Reimplantation for Benign Disease: A Population-Based Analysis.

Abstract

Background: Robot-assisted ureteral reimplantation (RAUR) is a relatively new minimally invasive procedure. As such, research is lacking, and the largest adult cohort studies include fewer than 30 patients. Our aim was to be the first population-based study to report on national utilization trends, factors associated with patient selection, inpatient outcomes, and the relative cost of RAUR for adults with benign ureteral disease (BUD). Materials and Methods: The National Inpatient Sample (2010-2015) was queried to identify all elective, nontransplant-related, open and robot-assisted reimplants for adult BUD. Survey-weighted logistic regression using Akaike Information Criterion identified patient-/hospital-level factors associated with robotic procedure. Survey-weighted regression models examined the association of robotic procedure with outcomes and charges. Results: A weighted total of 9088 cases were included: 1688 (18.6%) robot assisted and 7400 (81.4%) open. There were significantly increased odds of RAUR across consecutive years (odds ratio [OR] = 3.0, p < 0.001) and among patients operated on at private for-profit hospitals (OR: 2.1; p = 0.01), but significantly decreased odds among older patients (OR = 0.98, p < 0.001), those with Medicaid (OR = 0.5, p = 0.02), those with 2+ comorbidities (OR = 0.6, p = 0.009), and those operated on in western (OR = 0.5; p = 0.005) states. RAUR was significantly associated with a reduced length-of-stay (incidence rate ratio: 0.60; p < 0.001), decreased odds of blood transfusion (OR = 0.40; p < 0.001), and a lower mean ratio of total hospital charges (ratio: 0.71; p = 0.006). Conclusions: This is the first population-based study to report on the utilization and clinical benefits of RAUR for adult BUD. Open reimplantation remains the most common surgical technique utilized, despite the potential benefits of RAUR. Future research is needed to explore the mechanisms behind patient-/hospital-level factors and surgical selection. Work to investigate potential barriers in access to robotic procedure can help us provide equitable care across patient populations.