Presentation Authors: Marc Nelson*, Emanuel Eguia, Patrick Sweigert, Eric Kirshenbaum, Marcus Quek, Marshall Baker, Gopal Gupta, Maywood, IL
Introduction: Radical cystectomy is the standard surgical therapy for muscle-invasive bladder cancer. The RAZOR trial, which compared robot-assisted cystectomy to open found no difference in two-year progression-free survival. However, little is known about the cost differences between these two techniques. We sought to evaluate differences in costs between the approaches.
Methods: The Healthcare Cost and Utilization Project State Inpatient Databases for FL, MD, NY, and WA from 2012-2014 was queried. Patients with a diagnosis of bladder cancer (ICD-9 188x, 233.7) who had undergone radical cystectomy (ICD-9 57.71) were identified. Surgical approach was categorized as open or robot-assisted (ICD-9 17.4x). Costs were estimated from reported charges using hospital-specific cost to charge ratios. Rates of complications, LOS, and costs of care include all readmissions for 90 days following surgery. Univariate analysis was performed using Student's t-test, Pearson chi-square test, and Wilcoxon rank-sum test. A multivariable linear regression model was used to determine predictors of overall cost.
Results: 4,250 patients who underwent radical cystectomy for bladder cancer were identified. Of these, 23% were performed with robot assistance. The robotic approach was associated with lower rates of sepsis (7.15% vs. 10.36%, p=0.003), wound complications (6.13% vs 9.66%, p=0.001), pneumonia (3.17% vs 5.20%, p=0.019), and an improved overall LOS (9 vs 10 days, p < 0.005). There was no difference in 90 day readmission rate (38.95% vs 38.71%, p=0.496) or 90 day mortality (3.98% vs 3.49%, p=0.463). The total 90 day costs for robot-assisted and open techniques, including index admission, were $45,731 and $44,477 (p=0.3745), respectively. On multivariable analysis controlling for sex, age, race, insurance, type of diversion and comorbidity index, robotic cystectomy was cost equivalent to open (95% CI -$1374 to $4121).
Conclusions: In patients undergoing radical cystectomy for bladder cancer, robot-assistance is associated with lower rates of postoperative sepsis and shorter lengths of stay and is cost neutral as compared to open cystectomy.