National trends in the utilization of robotic-assisted radical cystectomy: An analysis using the Nationwide Inpatient Sample
National trends in the utilization of robotic-assisted radical cystectomy: An analysis using the Nationwide Inpatient Sample
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DOI：
10.1016/j.urolonc.2014.04.007
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发表时间：
2014-08-01
影响因子：
2.7
通讯作者：
Koch, Michael O.
中科院分区：
文献类型：
--
作者：
Monn, M. Francesca;Cary, K. Clint;Koch, Michael O.
目的：确定美国机器人辅助根治术（RARC）使用的时间和区域趋势，并探讨与机器人辅助使用相关的因素。材料和方法：使用2009年至2011年全国住院患者样本的数据，我们确定了使用开放式或机器人辅助进行的根治性膀胱炎病例，并应用全国住院患者样本出院重量来确定全国发病率。进行单变量和多变量logistic回归分析，以评估与RARC相关的区域趋势和特征。采用卡方检验、Student t检验和Mann-Whitney U检验进行描述性分析。结果：在29,719例根治性膀胱癌患者中，3,733例为RARC（12.6%）。尽管每年进行的RARC比例没有变化（P = 0.702）。开放性膀胱术的住院时间比RARC多1天（P < 0.001）。在多变量回归分析中，主要支付者是医疗补助的患者比私人保险患者更不可能接受RARC（比值比= 0.60，P = 0.074）。此外，南部患者接受RARC的几率降低了50%（比值比= 0.49，P = 0.044）。平均住院费用为5,000美元。结论：应监测新技术利用的地区差异，以确保平等获得新技术，并评估新技术的潜在过度使用。尽管RARC与较高的中位住院费用相关，但需要进一步研究以评估其益处。(C)2014爱思唯尔公司All rights reserved.
Objectives: To determine temporal and regional trends in utilization of robotic-assisted radical cystectomy (RARC) in the United States and to explore factors associated with utilization of robotic assistance.Materials and methods: Using 2009 to 2011 data from the Nationwide Inpatient Sample, we identified radical cystectomy cases that were performed using either open or robotic assistance and applied Nationwide Inpatient Sample discharge weights to determine national incidence. Univariable and multivariable logistic regressions were performed to assess regional trends and characteristics associated with having RARC. Descriptive analysis was performed using the chi-square test, the Student t test, and the Mann-Whitney U test.Results: Of the 29,719 radical cystectomy patients, 3,733 were RARC (12.6%). Although there was no change in the proportion of RARC performed annually (P = 0.702). Length of stay was 1 day longer for open cystectomy than RARC (P < 0.001). On multivariate regression, patients whose primary payer was Medicaid were less likely than private insurance patients to undergo RARC (odds ratio = 0.60, P = 0.074). Additionally, patients in the south were at 50% reduced odds of undergoing RARC (odds ratio = 0.49, P = 0.044). Median hospital costs were $5,000 greater for. RARC (P < 0.001).Conclusions: Regional variation in utilization should be monitored to ensure equal access to new technology and to assess potential overuse of new technology. Although RARC is associated with higher median hospital costs, further studies to assess its benefits are warranted. (C) 2014 Elsevier Inc. All rights reserved.