Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission

Jason F. Flamiatos, Yiyi Chen, William Lambert, Ann Martinez Acevedo, Thomas Becker, Jasper C. Bash, Christopher Amling

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien–Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20–0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalJournal of Robotic Surgery
DOIs
StateAccepted/In press - Jun 8 2018

Fingerprint

Patient Readmission
Cystectomy
Costs and Cost Analysis
Robotics
Linear Models
Operative Time
Blood Transfusion
Length of Stay
Cohort Studies
Retrospective Studies

Keywords

  • Bladder cancer
  • Complications
  • Cost
  • Open cystectomy
  • Readmissions
  • Robotic cystectomy

ASJC Scopus subject areas

  • Surgery
  • Health Informatics

Cite this

@article{bd5236efc3f644a9a1194edc516b1947,
title = "Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission",
abstract = "The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien–Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85{\%} compared to 66{\%} (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50{\%} versus 41{\%}, p = 0.01; 52{\%} versus 11{\%}, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11{\%} (p < 0.01). Patients in the open group experienced more major complications (19{\%} versus 10{\%}, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95{\%} CI 0.20–0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18{\%} reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.",
keywords = "Bladder cancer, Complications, Cost, Open cystectomy, Readmissions, Robotic cystectomy",
author = "Flamiatos, {Jason F.} and Yiyi Chen and William Lambert and {Martinez Acevedo}, Ann and Thomas Becker and Bash, {Jasper C.} and Christopher Amling",
year = "2018",
month = "6",
day = "8",
doi = "10.1007/s11701-018-0832-3",
language = "English (US)",
pages = "1--12",
journal = "Journal of Robotic Surgery",
issn = "1863-2483",
publisher = "Springer London",

}

TY - JOUR

T1 - Open versus robot-assisted radical cystectomy

T2 - 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission

AU - Flamiatos, Jason F.

AU - Chen, Yiyi

AU - Lambert, William

AU - Martinez Acevedo, Ann

AU - Becker, Thomas

AU - Bash, Jasper C.

AU - Amling, Christopher

PY - 2018/6/8

Y1 - 2018/6/8

N2 - The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien–Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20–0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.

AB - The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien–Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20–0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.

KW - Bladder cancer

KW - Complications

KW - Cost

KW - Open cystectomy

KW - Readmissions

KW - Robotic cystectomy

UR - http://www.scopus.com/inward/record.url?scp=85048305973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048305973&partnerID=8YFLogxK

U2 - 10.1007/s11701-018-0832-3

DO - 10.1007/s11701-018-0832-3

M3 - Article

C2 - 29948875

AN - SCOPUS:85048305973

SP - 1

EP - 12

JO - Journal of Robotic Surgery

JF - Journal of Robotic Surgery

SN - 1863-2483

ER -