In-Hospital Outcomes after Robotic Vs Open Radical Nephroureterectomy

Objective: To test whether the contemporary robot-assisted nephroureterectomy (RNU) is associated with more favorable in-hospital outcomes than historical RNU, relative to the same endpoints in open NU (ONU). Methods: Within the National Inpatient Sample (2008-2019), we identified RNU and ONU patients. Multivariable logistic and Poisson regression models were fitted. Results: Of 8032 NU patients, historical (2008-2013) vs contemporary (2014-2019) proportions were 776 (41%) vs 1104 (59%) for RNU and 3719 (60%) vs 2433 (40%) for ONU. The rates of RNU have increased over time (2008-2019; Δ absolute: +18%; p < 0.001). Contemporary RNU patients exhibited significantly better in-hospital outcomes in 6 of 12 comparisons vs historical that ranged from −54% for genitourinary complications to −12% for median length of stay (LOS). Contemporary ONU patients also exhibited significantly better in-hospital outcomes in 11 of 12 comparisons vs historical that ranged from −67% for blood transfusions to −26% for gastrointestinal complications. When historical RNU was compared with historical ONU, RNU in-hospital outcomes were better in 7 of 12 comparisons that ranged from −61% for median LOS to −16% for postoperative complications. Conversely, when contemporary RNU was compared with contemporary ONU, RNU in-hospital outcomes were only better in 2 of 12 comparisons: −25% cardiac complications and −13% for median LOS. Conclusion: The magnitude of in-hospital outcomes categories improvement between historical vs contemporary was two-fold more pronounced in ONU (11 improved categories) than in RNU (6 improved categories). Few outcome benefits remained (two categories only) when contemporary RNU was compared with contemporary ONU.