To evaluate the effect of the minimally invasive approach on spending and perioperative outcomes for patients undergoing radical cystectomy for bladder cancer. In a randomized control trial conducted at high volume centers, robotic and open cystectomy were shown to have similar outcomes. However, because the majority of cystectomies are performed in low-volume centers, it is unknown whether these findings are broadly generalizable.
We identified Medicare patients who underwent radical cystectomy for bladder cancer between 2008 and 2015. We examined the length of stay, readmission rate, and 90-day spending after minimally invasive or open cystectomy. We used multiple regression to estimate the association between minimally invasive surgery and the outcomes, accounting for patient, hospital, and surgeon factors that may influence these outcomes.
Of 4760 patients, 693 (14.6%) underwent minimally invasive cystectomy and 4,067 (85.4%) had an open approach. Minimally invasive cystectomy was associated with shorter length of stay (10.1 days v 11.9 days, P<0.001), but no difference in readmission rate (27.4% v 26.8%, P=0.77). Minimally invasive cystectomy was associated with lower adjusted 90-day episode spending ($34,369 v $38,071, P<0.001).
In patients across diverse institutions in the United States, minimally invasive cystectomy was associated with a shorter length of stay than open cystectomy and reduced 90-day episode spending, but with no significant difference in readmission rate.
Urology. 2018 Oct 23 [Epub ahead of print]
Parth K Modi, Brent K Hollenbeck, Mary Oerline, Alon Z Weizer, Jeffrey S Montgomery, Samuel D Kaffenberger, Andrew M Ryan, Chad Ellimoottil
University of Michigan, Department of Urology, Division of Urologic Oncology; University of Michigan, Department of Urology, Division of Health Services Research. Electronic address: ., University of Michigan, Department of Urology, Division of Urologic Oncology; University of Michigan, Department of Urology, Division of Health Services Research., University of Michigan, Department of Urology, Division of Health Services Research., University of Michigan, Department of Urology, Division of Urologic Oncology., Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.