MP40-03 POPULATION-BASED ANALYSIS OF COST AND PERI-OPERATIVE OUTCOMES BETWEEN OPEN AND ROBOTIC PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION FOR GERM CELL TUMORS

Abstract

You have accessJournal of UrologyPenile & Testicular Cancer I (MP40)1 Sep 2021MP40-03 POPULATION-BASED ANALYSIS OF COST AND PERI-OPERATIVE OUTCOMES BETWEEN OPEN AND ROBOTIC PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION FOR GERM CELL TUMORS Caleb Ashbrook, Raj Bhanvadia, Aditya Bagrodia, Yair Lotan, Vitaly Margulis, and Solomon Woldu Caleb AshbrookCaleb Ashbrook More articles by this author , Raj BhanvadiaRaj Bhanvadia More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Yair LotanYair Lotan More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , and Solomon WolduSolomon Woldu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002055.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While open retroperitoneal lymph node dissection (O-RPLND) has been the gold standard of treatment for germ cell tumors (GCT), robotic RPLND (R-RPLND) is gaining popularity as experience with robotic surgery increases. We therefore sought to compare perioperative outcomes and perform the first cost analysis between O-RPLND and R-RPLND using the Nationwide Inpatient Sample (NIS). METHODS: The NIS was queried for primary RPLND and GCT between 2013-2016. We compared cost, length of stay (LOS), and complications between O-RPLND and R-RPLND. Smoothed linear regression plots compared mean hospitalization cost by LOS and surgical approach to identify point of cost equivalence between the R-RPLND and O-RPLND. A multivariate linear regression model was generated to analyze predictors of cost adjusting for relevant factors. RESULTS: Our query identified 44 R-RPLND cases and 319 O-RPLND cases. R-RPLND was associated with a lower complication rate (0% vs 16.6%, p<0.01) and shorter LOS [Median(IQR): 1.5(1-3) vs 4(3-6) days, p<0.01]. On multivariate regression analysis, the robotic approach contributed $4,457 of additional cost, while each day of hospitalization contributed an additional $2,431; suggesting that a savings of approximately two days of hospitalization is required to offset the costs associated with robotic utilization. On smoothed linear regression analysis, the point of cost equivalence between a R-RPLND staying a mean of 2 days was between 4-5 days for O-RPLND, supporting the multivariate analysis. Total hospitalization cost was equivalent between R-RPLND and O-RPLND [Median(IQR): $15,681($12,735-$21,596) vs $16,718($11,799-$24,403), p=0.48], suggesting that the cost equivalency of R-RPLND is, at least in part, attributable to shorter LOS. CONCLUSIONS: While the open approach remains the gold standard for RPLND for GCT, our findings suggest primary R-RPLND may represent a cost-equivalent option with decreased LOS in carefully selected cases. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e714-e715 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caleb Ashbrook More articles by this author Raj Bhanvadia More articles by this author Aditya Bagrodia More articles by this author Yair Lotan More articles by this author Vitaly Margulis More articles by this author Solomon Woldu More articles by this author Expand All Advertisement Loading ...