Elio Mazzone1,2, Francesco A Mistretta1,3, Sophie Knipper1,4, Zhe Tian1, Alessandro Larcher2, Hugues Widmer1,5, Kevin Zorn1,5, Umberto Capitanio2, Markus Graefen4, Francesco Montorsi2, Shahrokh F Shariat6, Fred Saad1,5, Alberto Briganti2, Pierre I Karakiewicz1,5. 1. 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 2. 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 3. 3 Department of Urology, European Institute of Oncology, Milan, Italy. 4. 4 Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. 5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada. 6. 6 Department of Urology, Medical University of Vienna, Vienna, Austria.
Abstract
Background: The role of robot assistance is increasingly gaining importance among all major surgical uro-oncological procedures (MSUPs). However, contemporary analyses showed that total hospital charges (THCGs) related to robot-assisted procedures exceed those of open procedures. Based on increasing familiarity with robot-assisted surgery, we postulated that THCGs may have decreased over the past half-decade. Thus, we tested contemporary trends and THCGs related to robot-assisted vs nonrobot-assisted MSUPs. Materials and Methods: Within the National Inpatient Sample database (2009-2015), we identified patients who underwent robot-assisted vs nonrobot-assisted (open or laparoscopic) MSUPs, which included radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC). Rates of robot-assisted MSUPs were evaluated using estimated annual percentage changes (EAPCs) analyses. The t-test was used to examine statistically significant differences between mean THCGs according to either robot-assisted or nonrobot-assisted approach. Finally, linear regression analyses were tested for annual variation in the mean THCGs. Results: Of 128,367 MSUPs, 47.7% were robot-assisted. Overall, robot-assisted surgery rates among MSUPs increased from 40.3% to 57.6% (EAPC: +6.3%, p < 0.001) between 2009 and 2015. The mean THCGs for robot-assisted RP, RN, PN, and RC were $13,799, $18,789, $16,574, and $33,575, respectively. The observed mean THCGs differences between robot-assisted and nonrobot-assisted MSUPs were +$1594, +$1592, and +$1829 for RP, RN, and RC, respectively (all p < 0.05). Conversely, no statistically significant difference in the mean THCGs was reported between robot-assisted and nonrobot-assisted PN (+$367, p > 0.05). Finally, the annual observed mean THCGs linearly decreased for all robot-assisted MSUPs during the study period. Conclusions: Rates of robot-assisted MSUPs exponentially increased between 2009 and 2015. Although the mean THCGs decreased in a significant manner during the study period for all MSUPs, THCGs of robot-assisted RP, RN, and RC still exceed those of their respective nonrobot-assisted counterparts. Conversely, no differences in the mean THCGs were reported between robot-assisted vs nonrobot-assisted PN.
Background: The role of robot assistance is increasingly gaining importance among all major surgical uro-oncological procedures (MSUPs). However, contemporary analyses showed that total hospital charges (THCGs) related to robot-assisted procedures exceed those of open procedures. Based on increasing familiarity with robot-assisted surgery, we postulated that THCGs may have decreased over the past half-decade. Thus, we tested contemporary trends and THCGs related to robot-assisted vs nonrobot-assisted MSUPs. Materials and Methods: Within the National Inpatient Sample database (2009-2015), we identified patients who underwent robot-assisted vs nonrobot-assisted (open or laparoscopic) MSUPs, which included radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC). Rates of robot-assisted MSUPs were evaluated using estimated annual percentage changes (EAPCs) analyses. The t-test was used to examine statistically significant differences between mean THCGs according to either robot-assisted or nonrobot-assisted approach. Finally, linear regression analyses were tested for annual variation in the mean THCGs. Results: Of 128,367 MSUPs, 47.7% were robot-assisted. Overall, robot-assisted surgery rates among MSUPs increased from 40.3% to 57.6% (EAPC: +6.3%, p < 0.001) between 2009 and 2015. The mean THCGs for robot-assisted RP, RN, PN, and RC were $13,799, $18,789, $16,574, and $33,575, respectively. The observed mean THCGs differences between robot-assisted and nonrobot-assisted MSUPs were +$1594, +$1592, and +$1829 for RP, RN, and RC, respectively (all p < 0.05). Conversely, no statistically significant difference in the mean THCGs was reported between robot-assisted and nonrobot-assisted PN (+$367, p > 0.05). Finally, the annual observed mean THCGs linearly decreased for all robot-assisted MSUPs during the study period. Conclusions: Rates of robot-assisted MSUPs exponentially increased between 2009 and 2015. Although the mean THCGs decreased in a significant manner during the study period for all MSUPs, THCGs of robot-assisted RP, RN, and RC still exceed those of their respective nonrobot-assisted counterparts. Conversely, no differences in the mean THCGs were reported between robot-assisted vs nonrobot-assisted PN.
Authors: Erika Palagonia; Elio Mazzone; Geert De Naeyer; Frederiek D'Hondt; Justin Collins; Pawel Wisz; Fijs W B Van Leeuwen; Henk Van Der Poel; Peter Schatteman; Alexandre Mottrie; Paolo Dell'Oglio Journal: World J Urol Date: 2019-08-19 Impact factor: 4.226
Authors: Iulia Andras; Elio Mazzone; Fijs W B van Leeuwen; Geert De Naeyer; Matthias N van Oosterom; Sergi Beato; Tessa Buckle; Shane O'Sullivan; Pim J van Leeuwen; Alexander Beulens; Nicolae Crisan; Frederiek D'Hondt; Peter Schatteman; Henk van Der Poel; Paolo Dell'Oglio; Alexandre Mottrie Journal: World J Urol Date: 2019-11-27 Impact factor: 4.226
Authors: Alexandre Mottrie; Elio Mazzone; Peter Wiklund; Markus Graefen; Justin W Collins; Ruben De Groote; Paolo Dell'Oglio; Stefano Puliatti; Anthony G Gallagher Journal: BJU Int Date: 2020-12-20 Impact factor: 5.588