Comparative Analysis of Outcomes and Costs Following Open Radical Cystectomy Versus Robot-Assisted Laparoscopic Radical Cystectomy: Results From the US Nationwide Inpatient Sample

Menée à partir de données portant sur 1 668 patients américains, cette étude de cohorte observationnelle compare la morbidité, la mortalité, la durée du séjour hospitalier et les coûts associés à deux techniques de cystectomie radicale, l'une par par voie ouverte et l'autre par laparoscopie assistée par robot

Résumé en anglais

Background : Although robot-assisted laparoscopic radical cystectomy (RARC) was first reported in 2003 and has gained popularity, comparisons with open radical cystectomy (ORC) are limited to reports from high-volume referral centers.
Objective : To compare population-based perioperative outcomes and costs of ORC and RARC.
Design, setting, and participants : A retrospective observational cohort study using the US Nationwide Inpatient Sample to characterize 2009 RARC compared with ORC use and outcomes.
Outcome measurements and statistical analysis : Propensity score methods were used to compare inpatient morbidity and mortality, lengths of stay, and costs.
Results and limitations : We identified 1444 ORCs and 224 RARCs. Women were less likely to undergo RARC than ORC (9.8% compared with 15.5%, p = 0.048), and 95.7% of RARCs and 73.9% of ORCs were performed at teaching hospitals (p < 0.001). In adjusted analyses, subjects undergoing RARC compared with ORC experienced fewer inpatient complications (49.1% and 63.8%, p = 0.035) and fewer deaths (0% and 2.5%, p < 0.001). RARC compared with ORC was associated with lower parenteral nutrition use (6.4% and 13.3%, p = 0.046); however, there was no difference in length of stay. RARC compared with ORC was $3897 more costly (p = 0.023). Limitations include retrospective design, absence of tumor characteristics, and lack of outcomes beyond hospital discharge.
Conclusions : RARC is associated with lower parenteral nutrition use and fewer inpatient complications and deaths. However, lengths of stay are similar, and the robotic approach is significantly more costly.