Presentation Authors: Matthew Winter*, Shane Pearce, Giovanni Cacciamani, Carey Li, Akbar Ashrafi, Luis Medina, Djaladat Homan, Anne Schuckman, Sia Daneshmand, Andre Abreu, Andre Berger, Monish Aron, Inderbir Gill, Mihir Desai, Los Angeles , CA
Introduction: There is an increasing use of robotic radical cystectomy for treatment of bladder cancer with limited cost data comparisons to open surgery. We present our perioperative cost comparison between open and robotic radical cystectomy from a single institution.
Methods: Data were available on 986 patients undergoing curative intent radical cystectomy for bladder cancer using either an open (n=714) or robotic (n=272) approach in a prospectively maintained database. Propensity scores were obtained using age, gender, Charlson comorbidity index (CCI), diversion type, and year of surgery as model predictors. 1:1 matching was performed using nearest neighbor and a caliper of 0.5 yielding a matched cohort of 239 robotic vs 239 open cases. Total cost of hospitalization (primary outcome), variable cost, and individual cost center resource utilization (secondary outcomes) for the operative procedure admission were compared between the 2 groups using a t-test with a 0.05 level of significance.
Results: Both groups were comparable in terms of age, CCI, type of diversion, use of ERAS pathway, tumor, nodal stage and length of stay. The open approach was associated with a shorter operative time, reduced 90-day readmission rate, reduced high-grade complication rate, increased blood loss and increased need for transfusion (p < 0.001). The open and robotic approach was comparable in terms of total hospital cost ($59,801 vs $58,798 USD, p=0.73), and variable cost ($33,814 vs $32,696 USD, p=0.59). The robotic cohort had a greater operative room resource utilization (p < 0.0001), whereas the open group had a greater utilization of central supplies (p=0.02), and pharmacy resources (p=0.0003) (Table 1).
Conclusions: Propensity score matched comparison showed no differences in total or variable peri-operative costs between robotic and open surgery at a high volume academic medical center. The open approach used more central supplies and pharmacy. The robotic approach utilized more operating room resources. Future studies should include post-discharge costs up to 90 days and efficacy parameters to perform cost-effectiveness analyses.