BETHESDA, MD USA (UroToday.com) - Dr. Gelpi-Hammerschmidt and colleagues evaluated the Premier Hospital Database (Premier, Inc., Charlotte, NC USA) to assess utilization trends, morbidity, and costs associated with nephroureterectomy (NU). All patients who underwent NU with a diagnosis of renal pelvis or ureteral tumors from 2004-2013 were included. Regression models were created to assess 90-day post-operative complications, length of stay, OR time, and direct costs among open, laparoscopic, and robotic NU.
The authors found 17 245 open, 13 298 laparoscopic, and 3 745 robotic cases in the dataset. Minimally invasive surgeries increased from 36% to 54% over the time interval studied. The overall 90-day mortality was 1.89%, major complication rate was 9.4%, and minor complication rate was 27.7%, with no differences among the 3 approaches. Length of stay was shorter for laparoscopic (IRR 0.87, CI=0.82-0.92, p < 0.001) and robotic cases (IRR 0.76, CI=0.7-0.83, p < 0.001) compared to open NU. Meanwhile minimally invasive cases were longer than open cases (10.35 min. longer for laparoscopic, 56.35 min. longer for robotic, p < 0.05). Adjusted 90-day median direct hospital costs were $1 354 and $3 533 higher for laparoscopic and robotic NU (p < 0.001) vs open NU.
The authors conclude that the use of minimally invasive surgery has increased over time, with a surge in robotic cases, particularly in the patients with higher comorbidity. The overall decrease in NU has been attributed to a growing enthusiasm for renal-sparing approaches. Finally, comparable outcomes among the 3 approaches suggests that the morbidity profile is likely driven by patient characteristics.
Presented by:
Francisco Gelpi-Hammerschmidt,1 Christopher Allard,2 Jeffrey J. Leow,1 Benjamin I. Chung,3 and Steven L. Chang1
1Brigham and Women’s Hospital (Boston, MA USA); 2Massachusetts General Hospital (Boston, MA USA); 3Stanford University (Palo Alto, CA USA)
Reported by:
Nikhil Waingankar, MD* from the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA
*Fox Chase Cancer Center, Philadelphia, PA USA