Francesco DI Bello, Natali Rodriguez Peñaranda, Andrea Marmiroli, Mattia Longoni, Fabian Falkenbach, Quynh C LE, Zhe Tian, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Fred Saad, Shahrokh F Shariat, Salvatore Micali, Gennaro Musi, Alberto Briganti, Markus Graefen, Felix H Chun, Nicola Longo, Pierre I Karakiewicz
{"title":"Total hospital cost of robot-assisted approach in major urological cancer surgeries.","authors":"Francesco DI Bello, Natali Rodriguez Peñaranda, Andrea Marmiroli, Mattia Longoni, Fabian Falkenbach, Quynh C LE, Zhe Tian, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Fred Saad, Shahrokh F Shariat, Salvatore Micali, Gennaro Musi, Alberto Briganti, Markus Graefen, Felix H Chun, Nicola Longo, Pierre I Karakiewicz","doi":"10.23736/S2724-6051.25.06282-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"77 2","pages":"217-225"},"PeriodicalIF":4.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva Urology and Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S2724-6051.25.06282-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
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.
背景：本研究的目的是检验机器人辅助与开放式部分肾切除术（PN）、根治性膀胱切除术（RC）、根治性前列腺切除术（RP）和根治性肾输尿管切除术（NU）在医院总费用（THC）方面的差异。方法：在全国住院患者样本（2010-2019）中，我们确定了所有机器人辅助与开放式PN、RC、RP和NU患者。拟合了多变量泊松回归模型。结果：在所有手术中，机器人辅助PN （RPN）患者22572例（56%），机器人辅助RC （RARC）患者5114例（24%），机器人辅助RP （RARP）患者99134例（70%），机器人辅助NU （RNU）患者1138例（24%）。相对于开放手术，RARC （115,511 vs. 103,531美元）、RNU （64,761 vs. 54,768美元）、RARP （49,629 vs. 40,850美元）和RPN （56,288 vs. 50,875美元）与较高的THC相关(所有结论：在PN、RC、RP和NU患者中，当采用机器人辅助入路而不是开放入路时，THC总是较高的。机器人辅助方法的THC缺点需要考虑机器人辅助手术的其他好处，这些好处在当前的分析中无法解决。
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