The role of robot-assistance is increasingly gaining importance among all major surgical uro-oncological procedures (MSUPs). However, contemporary analyses showed that total hospital charges (THCGs) related to robot-assisted procedures exceed those of open procedures. Based on increasing familiarity with robot-assisted surgery, we postulated that THCGs may have decreased over the past half-decade. Thus, we tested contemporary trends and THCGs related to robot-assisted vs. non-robot-assisted MSUPs.
Within the National Inpatient Sample database (2009-2015), we identified patients who underwent robot-assisted vs. non-robot-assisted (open or laparoscopic) MSUPs, that included radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN) and radical cystectomy (RC). Robot-assisted MSUPs rates were evaluated using estimated annual percentage changes (EAPCs) analyses. The t-test was used to examine statistically significant differences between mean THCGs according to either robot-assisted and non-robot-assisted approach. Finally, linear regression analyses tested for annual variation in mean THCGs.
Of 128,367 MSUPs, 47.7% were robot-assisted. Overall, robot-assisted surgery rates among MSUPs increased from 40.3 to 57.6% (EAPC: +6.3%, p<0.001) between 2009-2015. Mean THCGs for robot-assisted RP, RN, PN and RC were, respectively, $ 13,799, $ 18,789, $ 16,574 and $ 33,575. Observed mean THCGs differences between robot-assisted and non-robot-assisted MSUPs were +$ 1,594, +$ 1,592 and +$ 1,829 for, respectively, RP, RN and RC (all p<0.05). Conversely, no statistically significant difference in mean THCGs was reported between robot-assisted and non-robot-assisted PN (+$ 367, p>0.05). Finally, annual observed mean THCGs linearly decreased for all robot-assisted MSUPs during the study period.
Robot-assisted MSUPs rates exponentially increased between 2009 and 2015. Although mean THCGs decreased in a significant fashion during the study period for all MSUPs, THCGs of robot-assisted RP, RN and RC still exceed those of their respective non-robot-assisted counterparts. Conversely, no differences in mean THCGs were reported between robot-assisted vs. non-robot-assisted PN.
Journal of endourology. 2019 Mar 30 [Epub ahead of print]
Elio Mazzone, Francesco Alessandro Mistretta, Sophie Knipper, Zhe Tian, Alessandro Larcher, Hugues Widmer, Kevin Christopher Zorn, Umberto Capitanio, Markus Graefen, Francesco Montorsi, Shahrokh F Shariat, Fred Saad, Alberto Briganti, Pierre I Karakiewicz
Ospedale San Raffaele, 9372 , Via Olgettina , Milano, Italy , 20132 ; ., Istituto Europeo di Oncologia, 9290, Urology , Via Ripamonti 435 , Milano, Italy , 20141., Hamburg, Germany ; ., Montreal, Canada ; ., Onze Lieve Vrouwziekenhuis, 37467, Urology, Aalst, Belgium ; ., Montreal, Canada ; ., University of Montreal, Urology , 388 Frontenac Dr , DDO, Quebec, Canada , H9G1R5 ; ., Milan, Italy ; ., Prostate Cancer Center Hamburg-Eppendorf, Martini-Clinic, Hamburg, Hamburg, Germany., Vita-Salute University, urology , Via Olgettina 60 , Milan, Italy , 20132 ; ., 1330 first avenue, 1024ny, New York, United States , 10021., Centre de recherche du CHUM, 177460, Montreal, Quebec, Canada ; ., Milan, Italy ; ., University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Quebec, Canada.