Outcomes of robotic-assisted versus open radical cystectomy in a large-scale, contemporary cohort of bladder cancer patients

  • Background and Objectives: To test for differences in perioperative outcomes and total hospital costs (THC) in nonmetastatic bladder cancer patients undergoing open (ORC) versus robotic-assisted radical cystectomy (RARC). Methods: We relied on the National Inpatient Sample database (2016–2019). Statistics consisted of trend analyses, multivariable logistic, Poisson, and linear regression models. Results: Of 5280 patients, 1876 (36%) versus 3200 (60%) underwent RARC versus ORC. RARC increased from 32% to 41% (estimated annual percentage change [EAPC]: + 8.6%; p = 0.02). Rates of transfusion (8% vs. 16%), intraoperative (2% vs. 3%), wound (6% vs. 10%), and pulmonary (6% vs. 10%) complications were lower in RARC patients (all p < 0.05). Moreover, median length of stay (LOS) was shorter in RARC (6 vs. 7days; p < 0.001). Conversely, median THC (31,486 vs. 27,162$; p < 0.001) were higher in RARC. Multivariable logistic regression-derived odds ratios addressing transfusion (0.49), intraoperative (0.53), wound (0.68), and pulmonary (0.71) complications favored RARC (all p < 0.01). In multivariable Poisson and linear regression models, RARC was associated with shorter LOS (Rate ratio:0.86; p < 0.001), yet higher THC (Coef.:5,859$; p < 0.001). RARC in-hospital mortality was lower (1% vs. 2%; p = 0.04). Conclusions: RARC complications, LOS, and mortality appear more favorable than ORC, but result in higher THC. The favorable RARC profile contributes to its increasing popularity throughout the United States.
Author:Robert Benedikt HöhORCiDGND, Rocco S. FlammiaORCiD, Lukas HohenhorstORCiD, Gabriele Sorce, Francesco ChierigoORCiD, Andrea Panunzio, Zhe Tian, Fred SaadGND, Michele Gallucci, Alberto Briganti, Carlo TerroneORCiDGND, Shahrokh F. ShariatGND, Markus GraefenGND, Derya TilkiORCiDGND, Alessandro Antonelli, Luis KluthORCiDGND, Andreas Becker, Felix ChunORCiDGND, Pierre I. Karakiewicz
Parent Title (English):Journal of surgical oncology
Place of publication:Bognor Regis [u.a.]
Document Type:Article
Date of Publication (online):2022/06/04
Date of first Publication:2022/06/04
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/03/17
Tag:bladder cancer; complication; open; outcomes; radical cystectomy; robotic-assisted
Page Number:8
First Page:830
Last Page:837
Open Access funding enabled and organized by Projekt DEAL.
All data generated for this study were from the National Inpatient Sample (NIS) database. The code for the analyses will be made available upon request.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International