MP61-09 PROPENSITY MATCHED COMPARISON OF MORBIDITY AND COSTS OF OPEN AND ROBOT-ASSISTED RADICAL CYSTECTOMIES: A CONTEMPORARY POPULATION-BASED ANALYSIS IN THE UNITED STATES

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2014MP61-09 PROPENSITY MATCHED COMPARISON OF MORBIDITY AND COSTS OF OPEN AND ROBOT-ASSISTED RADICAL CYSTECTOMIES: A CONTEMPORARY POPULATION-BASED ANALYSIS IN THE UNITED STATES Jeffrey Leow, Stephen Reese, Wei Jiang, Stuart Lipsitz, Joaquim Bellmunt, Quoc-Dien Trinh, Benjamin Chung, Adam Kibel, and Steven Chang Jeffrey LeowJeffrey Leow More articles by this author , Stephen ReeseStephen Reese More articles by this author , Wei JiangWei Jiang More articles by this author , Stuart LipsitzStuart Lipsitz More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Adam KibelAdam Kibel More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1886AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is increasing adoption of robotic technology in urology. Radical cystectomy (RC), the gold standard treatment for invasive bladder cancer, is a morbid procedure associated with high costs. Limited data are available regarding the impact of robotics on practice patterns and surgical outcomes. This study evaluates the morbidity and costs differences of open (ORC) versus robot-assisted radical cystectomies (RARC), using a contemporary population-based cohort in the United States. METHODS Using the Premier Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US, we captured all patients who underwent a RC (ICD-9 code 57.71) at 279 hospitals across the United States from 2004 to 2010. Propensity- and survey-weighted multivariable logistic and median regression analyses were performed to evaluate 90-day mortality, postoperative complication (Clavien classification) and readmission rates, length of stay, and direct hospital costs (including costs breakdowns). RESULTS The weighted cohort included 34672 ORC and 2101 RARC patients. The 90-day mortality rates (Clavien Grade 5; 3.8% vs. 2.5%, p=0.09; odds ratio [OR]: 1.3, 95% CI: 0.56-3.04, p=0.54) and major complication (Clavien Grade ≥3; 17.0% vs. 19.8%, p=0.2; OR: 1.32, 95% CI: 0.67-2.62, p=0.42) rates were similar between ORC and RARC. However, RARC had a 46% decreased odds of minor complications (Clavien Grade 1-2; OR: 0.54, 95% CI: 0.31 to 0.93, p=0.03). RARC had $4326 higher adjusted 90-day median direct hospital cost (p<0.001). Although RARC had a significantly shorter length of stay (-1.51 days, p<0.01), costs breakdowns reveal that there were no significant differences in room and board costs (p=0.2). Supplies costs for RARC were significantly higher (+$2403, p<0.0001) (Figure 1). CONCLUSIONS RARC was not associated with decreased risk of mortality or major complications although it was associated with significantly fewer minor complications compared with ORC. The direct hospital costs for RARC were significantly higher than for ORC and this difference was primarily attributed to higher supply costs. Data on the long-term oncological and functional outcomes differences are pending and will help determine if RARC is an appropriate approach given its higher cost profile. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e686 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jeffrey Leow More articles by this author Stephen Reese More articles by this author Wei Jiang More articles by this author Stuart Lipsitz More articles by this author Joaquim Bellmunt More articles by this author Quoc-Dien Trinh More articles by this author Benjamin Chung More articles by this author Adam Kibel More articles by this author Steven Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...