ロボット支援根治的膀胱摘除術と開腹根治的膀胱摘除術後の術後医療利用の差異：NSQIP分析

To compare 30-day healthcare utilization (HCU) following open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC). HCU was assessed using a composite endpoint including prolonged hospital stay, major postoperative complications, and discharge to a skilled nursing or rehabilitation facility.

We conducted a retrospective cohort analysis using the ACS-NSQIP database (2019-2022). Adults with bladder cancer who underwent RC were included; interfacility admissions were excluded. The primary outcome was high HCU, defined as ≥1 of: prolonged stay (≥8 days), major complication, or discharge to skilled nursing/rehabilitation. Multivariable logistic regression estimated the association between approach and HCU, adjusted for ASA class, stage, diversion, and frailty.

A total of 3,712 patients were included: 2,593 (69.8%) ORC and 1,119 (30.2%) RARC. Baseline demographics were similar, though ORC had more T4 disease (14% vs. 5%, p=0.017). In unadjusted analyses, RARC had lower HCU rates (31.5% vs. 57%, p=0.01). By domain, RARC had fewer major complications (25.6% vs. 48.2%), prolonged stays (9.7% vs. 19.1%), and discharges to continued care (6.3% vs. 10.2%) (all p=0.01). On adjusted analysis, RARC was associated with reduced odds of high HCU (aOR 0.51, 95% CI 0.41-0.63), prolonged stay (aOR 0.44, 0.35-0.56), discharge to continued care (aOR 0.61, 0.44-0.85), and major complications (aOR 0.38, 0.32-0.44).

Compared to ORC, RARC was independently associated with lower postoperative healthcare utilization, driven by fewer complications, shorter stays, and reduced need for continued care.