Short-term outcomes after robot-assisted versus open radical cystectomy for bladder cancer in patients with diabetes mellitus: an analysis of the United States Nationwide Inpatient Sample of 2005-2018.

Abstract

Introduction: Diabetes mellitus (DM) is associated with worse surgical outcomes, and is a risk factor for bladder cancer and subsequent oncological outcomes. This study evaluated outcomes robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) in patients with DM. Materials and Methods: Data of adults ≥ 18 years old with DM who underwent radical cystectomy were extracted from the United States National Inpatient Sample database 2005-2018. The outcomes were in-hospital mortality, prolonged length of stay (LOS), and postoperative complications. Results: Data of 2,765 patients were analyzed. Patients who received RARC had a significantly lower odds of prolonged LOS (adjusted odd ratio (aOR) = 0.56, 95% CI: 0.45, 0.71), unfavorable discharge (aOR = 0.74, 95% CI: 0.56, 0.97), urinary complications (aOR = 0.75, 95% CI: 0.57, 0.98) and wound and device-related complications (aOR = 0.59, 95% CI: 0.41, 0.86) than ORC. Of patients < 70 years old, RARC was significantly associated with decreased odds for urinary complications (aOR = 0.59, 95% CI: 0.41, 0.84) and wound and device-related complications (aOR = 0.55, 95% CI: 0.32, 0.94) compared to ORC. In patients with a Charlson Comorbidity Index score of 0-1, RARC was associated with a lower risk of urinary complications (aOR = 0.74, 95% CI: 0.56, 0.98) and wound and device-related complications (aOR = 0.63, 95% CI: 0.43, 0.93) compared to ORC. Conclusions: In patients with DM and bladder cancer, RARC appears to be associated with better short-term outcomes in terms of reduced risks of prolonged LOS, unfavorable discharge, urinary complications, and wound and device-related complications compared to ORC.