Comparison of In-Hospital Outcomes at Robot-Assisted Versus Open Partial Nephrectomy

The aim of this work is to quantify the magnitude of improvement in in-hospital outcomes between historical and contemporary robot-assisted partial nephrectomy (RPN) versus historical and contemporary open PN (OPN).

Within the Nationwide Inpatient Sample (2010-2019), we identified patients who underwent RPN and OPN. Multivariable logistic regression models were fit.

Historical (2010-2014) versus contemporary (2015-2019) proportions were 39% (n = 5,897) versus 61% (n = 9168) for RPN and 59% (n = 7289) versus 41% (n = 5,120) for OPN. Relative to historical, contemporary RPN patients exhibited significantly better in-hospital outcomes in 6 of 12 categories that ranged from-76% for intraoperative complications to-24% for length of stay (LOS) ≥ 75th percentile. Relative to historical, contemporary OPN patients also exhibited significantly better in-hospital outcomes in 7 of 12 categories that ranged from-76% for intraoperative complications to-23% for LOS ≥ 75th percentile. When historical RPN was compared with historical OPN, RPN in-hospital outcomes were better in 10 of 12 comparisons that ranged from-75% for LOS ≥ 75th percentile to-28% for perioperative bleeding. Similarly, when contemporary RPN was compared with contemporary OPN, RPN outcomes were better in 8 of 12 comparisons that ranged from-75% for LOS ≥ 75th percentile to-27% for postoperative complications.

The magnitude of improvement in in-hospital outcomes was more pronounced for contemporary versus historical OPN (seven improved categories) than for contemporary versus historical RPN (six improved categories). However, contemporary RPN outperformed contemporary OPN patients in eight in-hospital outcome categories.