Open versus Minimally Invasive Nephroureterectomy: Contemporary Analysis from a Wide National Population-Based...

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Minimally invasive nephroureterectomy (MINU), particularly robotic-assisted laparoscopy, is increasingly adopted in healthcare.
• Open nephroureterectomy (ONU) has been the traditional approach for this procedure.

Purpose of the Study:

• To investigate contemporary trends in the adoption of MINU versus ONU in the United States.
• To compare postoperative complication rates and analyze factors influencing outcomes, including social determinants of health (SDOH).

Main Methods:

• Retrospective analysis of 15,240 patients undergoing ONU or MINU between 2011-2021 using an all-payer insurance claims database.
• Utilized International Classification of Diseases codes to identify procedures, patient characteristics, SDOH, and complications.
• Multivariable regression models were employed to compare outcomes.

Main Results:

• MINU utilization rose from 29% to 72% during the study period, while ONU declined (p=0.01).
• The 60-day postoperative complication rate was lower for MINU (19%) compared to ONU (23%) (p<0.001).
• ONU was associated with a significantly higher risk of postoperative complications (OR 1.33).

Conclusions:

• A significant national shift towards MINU, replacing ONU, has been confirmed.
• Minimally invasive approaches are linked to a reduced risk of surgical complications.
• Social determinants of health (SDOH) did not significantly impact nephroureterectomy outcomes in this study.