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.
Total hospital cost of robot-assisted approach in major urological cancer surgeries / DI BELLO, Francesco; RODRIGUEZ PEÑARANDA, Natali; Marmiroli, Andrea; Longoni, Mattia; Falkenbach, Fabian; Le, Quynh C.; Tian, Zhe; Goyal, Jordan A.; COLLa RUVOLO, Claudia; Califano, Gianluigi; Creta, Massimiliano; Saad, Fred; Shariat, Shahrokh F.; Micali, Salvatore; Musi, Gennaro; Briganti, Alberto; Graefen, Markus; Chun, Felix H.; Longo, Nicola; Karakiewicz, Pierre I.. - In: MINERVA UROLOGY AND NEPHROLOGY. - ISSN 2724-6051. - 77:2(2025). [10.23736/s2724-6051.25.06282-2]
Total hospital cost of robot-assisted approach in major urological cancer surgeries
DI BELLO, Francesco;COLLa RUVOLO, Claudia;CALIFANO, Gianluigi;CRETA, Massimiliano;MUSI, Gennaro;LONGO, Nicola;
2025
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
