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Updated: May 9, 2025
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Published on: February 12, 2022
Total hospital cost of robot-assisted approach in major urological cancer surgeries
Francesco DI Bello1,2, Natali Rodriguez Peñaranda3,4, Andrea Marmiroli3,5,6
1Division of Urology, Unit of Cancer Prognostics and Health Outcomes, University of Montréal Health Center, Montréal, QB, Canada - fran.dibello12@gmail.com.
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.
