Comparing the Costs and Benefits of Open vs Robotic Simple Prostatectomy
Catherine Gu, MD, Martin Kathrins, MD, Steven Chang, MD.
Brigham and Women's, Boston, MA, USA.
BACKGROUND: With the rise of robotic surgery, there has been much debate on the cost/benefit of robotic vs open surgery. However, most studies examining the outcomes and costs of robotic surgery have been done in the context of robotic-assisted laparoscopic radical prostatectomy (RALP). While urologic robotic surgery has expanded to other procedures such as cystectomies and simple prostatectomies, the cost/benefit of such robotic approaches has not been as well studied. In this analysis, we sought to examine the monetary costs, hospital resource utilization, and short-term complications of robotic vs open simple prostatectomy in a national cohort.
METHODS: We performed a retrospective cohort study of adult men undergoing elective open and robotic simple prostatectomy from 2008 to 2017. The data were abstracted from the Premier Hospital Database, a national hospital discharge dataset representing approximately 20% of non-federal hospital discharges in the United States. We assessed for an association between surgical approach (open vs robotic) and postoperative outcomes including surgical complications, operating room time, need for blood transfusion, length of stay, readmissions and overall costs. All multivariable regression models were controlled for clinical, demographic and hospital factors.
RESULTS: A total of 7,781 men in the study cohort underwent a simple prostatectomy during the study period of which 7,069 (90.85%) were open and 712 (9.15%) were robotic. There were no differences between the surgical approaches for 90-day minor (Clavien grade 1-2) and major (Clavien grade 3-5) complications although the open approach was more commonly associated with blood transfusion (OR: 1.47, 95% CI: 1.11 to 1.94, p=0.007). The robotic approach was associated with a longer median operating room time (+105 min, 95% CI: 97 to 113 min, p<0.0001), a shorter hospitalization (-1 day, 95% CI: -1.14 to -0.86 days, p<0.0001), and a higher odds for 90-day readmission (OR: 1.26, 95% CI: 1.04 to 1.54, p=0.021). The 90-day cost was significantly higher for robotic simple prostatectomy (+US$4,448, 95% CI: $4,011 to $4,886, p<0.0001).
CONCLUSIONS: In the largest known cohort of simple open vs robotic prostatectomies, the 90-day cost of robotic prostatectomy was significantly higher despite the shorter hospital length of stay—likely due to higher equipment costs and longer operative times—with no differences in major or minor complications.
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