Utilization Trends and Short-term Outcomes of Robotic Versus Open Radical Cystectomy for Bladder Cancer

To compare utilization trends and short-term outcomes of robotic versus open radical cystectomy for bladder cancer since the introduction of the robotic modifier (ICD-9 17.4x).

Using the Statewide Planning and Research Cooperative System database, an all-payer administrative system on all hospital discharges in New York State, we identified patients undergoing radical cystectomy (57.71) with a diagnosis of bladder cancer (188.0-188.9, 233.7, 236.7) from October 2008 to December 2012. Primary outcomes were inpatient complications and mortality at index stay.

Of the 2525 patients, 24.2% (610 of 2525) underwent robotic and 75.8% (1915 of 2525) underwent open radical cystectomy. The proportion of robotic cases increased from 19.9% (119 of 597) in 2009 to 28.9% (173 of 598) in 2012 (P < .05). From 2009 to 2012, the number of open surgeons decreased from 117 to 109, and that of robotic increased from 56 to 66. Robotic patients had lower approach-specific surgeon and hospital volume, and more likely underwent lymph node dissection, ileal conduit diversion, blood transfusion, and prolonged length of stay. On multivariate analysis, robotic approach conferred a reduced risk of blood transfusion (odds ratio: 0.600, 95% confidence interval: 0.492-0.732, P < .0005) but had no association with prolonged length of stay. There were no significant differences in inpatient complications or mortality at index stay, parenteral nutrition, length of stay, hospital charges, readmission rates up to 90 days, or mortality up to 90 days between the surgical approaches.

Despite the rapid dissemination and more recent experience of robotic radical cystectomy, we report lower rates of blood transfusion and otherwise similar short-term outcomes with open radical cystectomy.