Comparison of Perioperative Outcomes between Open and Robotic Radical Cystectomy: A Population-Based Analysis

Sebastiano Nazzani, Elio Mazzone, Felix Preisser, Marco Bandini, Zhe Tian, Michele Marchioni, Dario Ratti, Gloria Motta, Kevin C. Zorn, Alberto Briganti, Shahrokh F. Shariat, Emanuele Montanari, Luca Carmignani, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

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Abstract

Introduction: Radical cystectomy represents the standard of care for muscle-invasive bladder cancer (MIBC). Due to its novelty the use of robotic radical cystectomy (RARC) is still under debate. We examined intraoperative and postoperative morbidity and mortality in addition to impact on length of stay (LOS) and total hospital charges (THCGs) of RARC compared with open radical cystectomy (ORC). Materials and Methods: Within National Inpatient Sample (2008-2013), we identified patients with nonmetastatic bladder cancer treated with either ORC or RARC. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between ORC vs RARC. Multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used. Results: Of all 10,027 patients, 12.6% underwent RARC. Between 2008 and 2013, RARC rates increased from 0.8% to 20.4% [estimated annual percentage change (EAPC): +26.5%, 95% confidence interval (CI): +11.1 to +48.3; p = 0.035] and RARC THCGs decreased from 45,981 to 31,749 United States dollars (EAPC: -6.8%, 95% CI: -9.6 to -3.9; p = 0.01). In MLR models RARC resulted in lower rates of overall complications [odds ratio (OR): 0.6; p < 0.001] and transfusions (OR: 0.44; p < 0.001). In MPR models, RARC was associated with shorter LOS (relative risk 0.91; p < 0.001). Finally, higher THCGs (OR: 1.09; p < 0.001) were recorded for RARC. Data are retrospective and no tumor characteristics were available. Conclusion: RARC is related to lower rates of overall complications and transfusions rates. In consequence, RARC is a safe and feasible technique in select MIBC patients. Moreover, RARC is associated with shorter LOS, although higher THCGs.

Original languageEnglish
Pages (from-to)701-709
Number of pages9
JournalJournal of Endourology
Volume32
Issue number8
DOIs
Publication statusPublished - Aug 1 2018

Fingerprint

Cystectomy
Robotics
Hospital Charges
Urinary Bladder Neoplasms
Length of Stay
Population
Logistic Models
Odds Ratio
Confidence Intervals
Muscles
Standard of Care
Inpatients
Morbidity
Mortality
Neoplasms

Keywords

  • bladder cancer
  • cystectomy
  • National Inpatient Sample
  • robotic surgery

ASJC Scopus subject areas

  • Urology

Cite this

Nazzani, S., Mazzone, E., Preisser, F., Bandini, M., Tian, Z., Marchioni, M., ... Karakiewicz, P. I. (2018). Comparison of Perioperative Outcomes between Open and Robotic Radical Cystectomy: A Population-Based Analysis. Journal of Endourology, 32(8), 701-709. https://doi.org/10.1089/end.2018.0313

Comparison of Perioperative Outcomes between Open and Robotic Radical Cystectomy : A Population-Based Analysis. / Nazzani, Sebastiano; Mazzone, Elio; Preisser, Felix; Bandini, Marco; Tian, Zhe; Marchioni, Michele; Ratti, Dario; Motta, Gloria; Zorn, Kevin C.; Briganti, Alberto; Shariat, Shahrokh F.; Montanari, Emanuele; Carmignani, Luca; Karakiewicz, Pierre I.

In: Journal of Endourology, Vol. 32, No. 8, 01.08.2018, p. 701-709.

Research output: Contribution to journalArticle

Nazzani, S, Mazzone, E, Preisser, F, Bandini, M, Tian, Z, Marchioni, M, Ratti, D, Motta, G, Zorn, KC, Briganti, A, Shariat, SF, Montanari, E, Carmignani, L & Karakiewicz, PI 2018, 'Comparison of Perioperative Outcomes between Open and Robotic Radical Cystectomy: A Population-Based Analysis', Journal of Endourology, vol. 32, no. 8, pp. 701-709. https://doi.org/10.1089/end.2018.0313
Nazzani, Sebastiano ; Mazzone, Elio ; Preisser, Felix ; Bandini, Marco ; Tian, Zhe ; Marchioni, Michele ; Ratti, Dario ; Motta, Gloria ; Zorn, Kevin C. ; Briganti, Alberto ; Shariat, Shahrokh F. ; Montanari, Emanuele ; Carmignani, Luca ; Karakiewicz, Pierre I. / Comparison of Perioperative Outcomes between Open and Robotic Radical Cystectomy : A Population-Based Analysis. In: Journal of Endourology. 2018 ; Vol. 32, No. 8. pp. 701-709.
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abstract = "Introduction: Radical cystectomy represents the standard of care for muscle-invasive bladder cancer (MIBC). Due to its novelty the use of robotic radical cystectomy (RARC) is still under debate. We examined intraoperative and postoperative morbidity and mortality in addition to impact on length of stay (LOS) and total hospital charges (THCGs) of RARC compared with open radical cystectomy (ORC). Materials and Methods: Within National Inpatient Sample (2008-2013), we identified patients with nonmetastatic bladder cancer treated with either ORC or RARC. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between ORC vs RARC. Multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used. Results: Of all 10,027 patients, 12.6{\%} underwent RARC. Between 2008 and 2013, RARC rates increased from 0.8{\%} to 20.4{\%} [estimated annual percentage change (EAPC): +26.5{\%}, 95{\%} confidence interval (CI): +11.1 to +48.3; p = 0.035] and RARC THCGs decreased from 45,981 to 31,749 United States dollars (EAPC: -6.8{\%}, 95{\%} CI: -9.6 to -3.9; p = 0.01). In MLR models RARC resulted in lower rates of overall complications [odds ratio (OR): 0.6; p < 0.001] and transfusions (OR: 0.44; p < 0.001). In MPR models, RARC was associated with shorter LOS (relative risk 0.91; p < 0.001). Finally, higher THCGs (OR: 1.09; p < 0.001) were recorded for RARC. Data are retrospective and no tumor characteristics were available. Conclusion: RARC is related to lower rates of overall complications and transfusions rates. In consequence, RARC is a safe and feasible technique in select MIBC patients. Moreover, RARC is associated with shorter LOS, although higher THCGs.",
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T2 - A Population-Based Analysis

AU - Nazzani, Sebastiano

AU - Mazzone, Elio

AU - Preisser, Felix

AU - Bandini, Marco

AU - Tian, Zhe

AU - Marchioni, Michele

AU - Ratti, Dario

AU - Motta, Gloria

AU - Zorn, Kevin C.

AU - Briganti, Alberto

AU - Shariat, Shahrokh F.

AU - Montanari, Emanuele

AU - Carmignani, Luca

AU - Karakiewicz, Pierre I.

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N2 - Introduction: Radical cystectomy represents the standard of care for muscle-invasive bladder cancer (MIBC). Due to its novelty the use of robotic radical cystectomy (RARC) is still under debate. We examined intraoperative and postoperative morbidity and mortality in addition to impact on length of stay (LOS) and total hospital charges (THCGs) of RARC compared with open radical cystectomy (ORC). Materials and Methods: Within National Inpatient Sample (2008-2013), we identified patients with nonmetastatic bladder cancer treated with either ORC or RARC. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between ORC vs RARC. Multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used. Results: Of all 10,027 patients, 12.6% underwent RARC. Between 2008 and 2013, RARC rates increased from 0.8% to 20.4% [estimated annual percentage change (EAPC): +26.5%, 95% confidence interval (CI): +11.1 to +48.3; p = 0.035] and RARC THCGs decreased from 45,981 to 31,749 United States dollars (EAPC: -6.8%, 95% CI: -9.6 to -3.9; p = 0.01). In MLR models RARC resulted in lower rates of overall complications [odds ratio (OR): 0.6; p < 0.001] and transfusions (OR: 0.44; p < 0.001). In MPR models, RARC was associated with shorter LOS (relative risk 0.91; p < 0.001). Finally, higher THCGs (OR: 1.09; p < 0.001) were recorded for RARC. Data are retrospective and no tumor characteristics were available. Conclusion: RARC is related to lower rates of overall complications and transfusions rates. In consequence, RARC is a safe and feasible technique in select MIBC patients. Moreover, RARC is associated with shorter LOS, although higher THCGs.

AB - Introduction: Radical cystectomy represents the standard of care for muscle-invasive bladder cancer (MIBC). Due to its novelty the use of robotic radical cystectomy (RARC) is still under debate. We examined intraoperative and postoperative morbidity and mortality in addition to impact on length of stay (LOS) and total hospital charges (THCGs) of RARC compared with open radical cystectomy (ORC). Materials and Methods: Within National Inpatient Sample (2008-2013), we identified patients with nonmetastatic bladder cancer treated with either ORC or RARC. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between ORC vs RARC. Multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used. Results: Of all 10,027 patients, 12.6% underwent RARC. Between 2008 and 2013, RARC rates increased from 0.8% to 20.4% [estimated annual percentage change (EAPC): +26.5%, 95% confidence interval (CI): +11.1 to +48.3; p = 0.035] and RARC THCGs decreased from 45,981 to 31,749 United States dollars (EAPC: -6.8%, 95% CI: -9.6 to -3.9; p = 0.01). In MLR models RARC resulted in lower rates of overall complications [odds ratio (OR): 0.6; p < 0.001] and transfusions (OR: 0.44; p < 0.001). In MPR models, RARC was associated with shorter LOS (relative risk 0.91; p < 0.001). Finally, higher THCGs (OR: 1.09; p < 0.001) were recorded for RARC. Data are retrospective and no tumor characteristics were available. Conclusion: RARC is related to lower rates of overall complications and transfusions rates. In consequence, RARC is a safe and feasible technique in select MIBC patients. Moreover, RARC is associated with shorter LOS, although higher THCGs.

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