Short-term Outcomes and Costs Following Partial Nephrectomy in England: A Population-based Study

Abstract

BackgroundThe benefits of minimally invasive partial nephrectomy (PN) for localised renal cancers are well established. Outcomes and hospital activity following PN have not been studied for the English National Health System, despite a growing use of robotic-assisted PN (RAPN). ObjectiveTo compare 90-d complication rates and 1-yr hospital activity and costs following PN using routinely-collected national data. Design, setting, and participantsWe analysed Hospital Episode Statistics data for 4275 patients undergoing open PN (OPN), laparoscopic PN, or RAPN between October 2008 and September 2014. Outcome measurements and statistical analysisHospital activity and costs estimated using multivariate Generalised Linear Models. Logistic regression was used to model postoperative complications. Results and limitationsCompared with RAPN, OPN experienced more frequent 90-d readmissions for wound-related complications (n=68 vs n=3, p=0.014) and postoperative infections (n=151 vs n=11, p=0.045). One-year inpatient admissions were higher in OPN (incidence rate: 1.628 vs 0.928, p=0.004). Outcomes in laparoscopic PN and RAPN were equivalent. In comparison to OPN, RAPN was associated with lower complication-related costs at 90 d (mean £317.21 vs £129.29, p=0.002) and total costs at 1 yr (mean £2998.55 vs £2089.37, p=0.024). Limitations were the absence of clinical indicators for risk adjustment. ConclusionsHospital activity is significantly lower in the year immediately following RAPN compared with OPN. This is driven in part by a reduction in postoperative complications requiring readmission, reflecting lower total costs. Patient summaryWe analysed national data for 4275 patients undergoing partial nephrectomy via open, laparoscopic, or robotic assisted laparoscopic surgery in England over a 6-yr period. Robotic assisted laparoscopic surgery was associated with fewer 90-d complications and lower total costs at 1-yr postintervention.