Propensity-Matched Comparison of Morbidity and Costs of Open and Robot-Assisted Radical Cystectomies: A Contemporary Population-Based Analysis in the United States
Propensity-Matched Comparison of Morbidity and Costs of Open and Robot-Assisted Radical Cystectomies: A Contemporary Population-Based Analysis in the United States
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DOI：
10.1016/j.eururo.2014.01.029
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发表时间：
2014-09-01
期刊：
影响因子：
23.4
通讯作者：
Chang, Steven L.
中科院分区：
文献类型：
--
作者：
Leow, Jeffrey J.;Reese, Stephen W.;Chang, Steven L.
背景：根治性膀胱癌（RC）是一种病态的手术，费用高。机器人辅助RC（RARC）与开放RC（ORC）相比的并发症特征和成本的基于人群的数据有限。目的：评估ORC和RARC之间的发病率和成本差异。设计、设置和参与者：我们进行了一个基于人口的，对2004年至2010年间在美国279家医院接受RC的患者进行回顾性队列研究。统计学分析：采用多变量logistic回归和中位数回归评估90天死亡率、术后并发症（Clavien分类）、再入院率、住院时间（LOS）和直接费用。为了减少选择偏差，我们使用倾向加权与调查加权，以获得全国代表性estimations.Results和局限性：最终加权队列包括34 672 ORC和2101 RARC患者。RARC的使用率从2004年的0.6%上升到2010年的12.8%。ORC和RARC之间的严重并发症发生率（Clavien分级>= 3; 17.0% vs 19.8%，p = 0.2）相似（比值比[ OR]：1.32; p = 0.42）。RARC使轻微并发症的几率降低了46%（Clavien 1-2级; OR：0.54; p = 0.03）。RARC有4326美元更高的调整后90天的直接成本中位数（p = 0.004）。尽管RARC的LOS显著缩短（11.8 d vs 10.2 d; p = 0.008），但在食宿费用方面没有显著差异（p = 0.20）。RARC的供应成本显著较高（6041美元对3638美元; p < 0.0001）。在手术量最大的外科医生（>= 7例/年）和医院（> 19例/年）之间不存在死亡率和成本差异。局限性包括使用的行政数据库和缺乏肿瘤学特征。结论：使用的RARC在2004年和2010年之间增加。与ORC相比，RARC与轻微但非严重并发症的几率降低相关，并且主要由于供应成本较高而导致支出增加。将ORC和RARC集中到高容量供应商可以最大限度地减少这些发病率和成本差异。患者总结：使用基于美国人群的队列，我们发现膀胱癌机器人手术减少了轻微并发症，对主要并发症没有影响，并且比开放手术更昂贵。(C)2014年欧洲泌尿外科协会。由Elsevier B出版。V.保留所有权利。
Background: Radical cystectomy (RC) is a morbid procedure associated with high costs. Limited population-based data exist on the complication profile and costs of robotassisted RC (RARC) compared with open RC (ORC).Objective: To evaluate morbidity and cost differences between ORC and RARC.Design, setting, and participants: We conducted a population-based, retrospective cohort study of patients who underwent RC at 279 hospitals across the United States between 2004 and 2010.Outcome measurements and statistical analysis: Multivariable logistic and median regression was performed to evaluate 90-d mortality, postoperative complications (Clavien classification), readmission rates, length of stay (LOS), and direct costs. To reduce selection bias, we used propensity weighting with survey weighting to obtain nationally representative estimates.Results and limitations: The final weighted cohort included 34 672 ORC and 2101 RARC patients. RARC use increased from 0.6% in 2004 to 12.8% in 2010. Major complication rates (Clavien grade >= 3; 17.0% vs 19.8%, p = 0.2) were similar between ORC and RARC (odds ratio [ OR]: 1.32; p = 0.42). RARC had 46% decreased odds of minor complications (Clavien grade 1-2; OR: 0.54; p = 0.03). RARC had $ 4326 higher adjusted 90-d median direct costs (p = 0.004). Although RARC had a significantly shorter LOS (11.8 d vs 10.2 d; p = 0.008), no significant differences in room and board costs existed (p = 0.20). Supply costs for RARC were significantly higher ($ 6041 vs $ 3638; p < 0.0001). Morbidity and cost differences were not present among the highest-volume surgeons (>= 7 cases per year) and hospitals (> 19 cases per year). Limitations include use of an administrative database and lack of oncologic characteristics.Conclusions: The use of RARC has increased between 2004 and 2010. Compared with ORC, RARC was associated with decreased odds of minor but not major complications and with increased expenditures attributed primarily to higher supply costs. Centralization of ORC and RARC to high-volume providers may minimize these morbidity and cost differences. Patient summary: Using a US population-based cohort, we found that robotic surgery for bladder cancer decreased minor complications, had no impact on major complications and was more costly than open surgery. (C) 2014 European Association of Urology. Published by Elsevier B. V. All rights reserved.