Total hospital cost of robot-assisted approach in major urological cancer surgeries

Abstract

BACKGROUND: The aim of this study was to test for differences in total hospital cost (THC) between robot-assisted vs. open partial nephrectomy (PN), radical cystectomy (RC), radical prostatectomy (RP) and radical nephroureterectomy (NU). METHODS: Within the National Inpatient Sample (2010-2019), we identified all robot-assisted vs. open PN, RC, RP and NU patients. Multivariable Poisson regression models were fitted. RESULTS: Of all surgeries, 22,572 (56%) were robot-assisted PN (RPN), 5114 (24%) were robot-assisted RC (RARC), 99,134 (70%) were robot-assisted RP (RARP), and 1138 (24%) patients were robot-assisted NU (RNU). Relative to open surgery, RARC (115,511 vs. 103,531$), RNU (64,761 vs. 54,768$), RARP (49,629 vs. 40,850$) and RPN (56,288 vs. 50,875$) were associated with higher THC (all P<0.001). After multivariable adjustment, RARP (risk ratio [RR]: 1.25), RNU (RR: 1.13), RPN (RR: 1.11) as well as RARC (RR: 1.10) independently predicted higher THC (all P<0.001). Additionally, Charlson Comorbidity Index ≥2 (RR: from 1.07 to 1.08), large bed size hospitals (RR: from 1.03 to 1.08), length of stay (RR: from 1.02 to 1.06), and overall complications (RR: from 1.09 to 1.19) invariably predicted higher THC. CONCLUSIONS: THC is invariably higher when robot-assisted approach is applied instead of open approach in PN, RC, RP and NU patients. This THC disadvantage of robot-assisted approach requires consideration in the light of other benefits of robot-assisted surgery that could not be addressed in the current analyses.