Jeong IG, et al. - The trend in utilization of robotic-assisted operations for radical nephrectomy in the United States and comparison of perioperative outcomes and costs with laparoscopic radical nephrectomy were investigated in this study. The outcome revealed that the utilization of robotic-assisted surgery increased substantially among patients undergoing radical nephrectomy for the renal mass between 2003 and 2015. The utilization of robotic-assistance was not related to increased risk of any or major complications but was related to prolonged operating time and higher hospital costs compared with laparoscopic surgery.

Methods

• For this research, they designed a retrospective cohort study.
• They used the Premier Healthcare database to assess outcomes of patients who had undergone robotic-assisted or laparoscopic radical nephrectomy for renal mass.
• This study was conducted at 416 US hospitals between January 2003 and September 2015.
• Multivariable regression modeling was utilized to evaluate outcomes.

Results

• Total 23753 patients were included in this study.
• 61.4 years was the mean age, 58.1% 13792 men were considered in this study.
• Out of them, 18573 patients underwent laparoscopic radical nephrectomy and 5180 underwent robotic-assisted radical nephrectomy.
• Utilization of robotic-assisted surgery increased from 1.5% (39 of 2676 radical nephrectomy procedures in 2003) to 27.0% (862 of 3194 radical nephrectomy procedures) in 2015 (P for trend <.001).
• In the weighted-adjusted analysis, no significant differences were seen between robotic-assisted and laparoscopic radical nephrectomy in the incidence of any (Clavien grades 1-5) postoperative complications (adjusted rates, 22.2% vs 23.4%, difference, -1.2%; 95% CI, -5.4 to 3.0%) or major (Clavien grades 3-5) complications (adjusted rates, 3.5% vs 3.8%, difference, -0.3%; 95% CI, -1.0% to 0.5%).
• The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure in the adjusted analysis (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%).
• Robotic-assisted radical nephrectomy was related to higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519), mainly accounted for operating room ($7217 vs $5378; difference, $1839; 95% CI, $1050 to $2628) and supply costs ($4876 vs $3891; difference, $985; 95% CI, $473 to $1498).