title: Comparative analysis of outcomes and costs following open radical cystectomy versus robot-assisted laparoscopic radical cystectomy: results from the US Nationwide Inpatient Sample.
abstract: BACKGROUND
  Although robot-assisted laparoscopic radical cystectomy (RARC) was first reported in 2003 and has gained popularity, comparisons with open radical cystectomy (ORC) are limited to reports from high-volume referral centers.
  
  
  OBJECTIVE
  To compare population-based perioperative outcomes and costs of ORC and RARC.
  
  
  METHODS
  A retrospective observational cohort study using the US Nationwide Inpatient Sample to characterize 2009 RARC compared with ORC use and outcomes.
  
  
  METHODS
  Propensity score methods were used to compare inpatient morbidity and mortality, lengths of stay, and costs.
  
  
  CONCLUSIONS
  We identified 1444 ORCs and 224 RARCs. Women were less likely to undergo RARC than ORC (9.8% compared with 15.5%, p = 0.048), and 95.7% of RARCs and 73.9% of ORCs were performed at teaching hospitals (p<0.001). In adjusted analyses, subjects undergoing RARC compared with ORC experienced fewer inpatient complications (49.1% and 63.8%, p = 0.035) and fewer deaths (0% and 2.5%, p<0.001). RARC compared with ORC was associated with lower parenteral nutrition use (6.4% and 13.3%, p = 0.046); however, there was no difference in length of stay. RARC compared with ORC was $3797 more costly (p = 0.023). Limitations include retrospective design, absence of tumor characteristics, and lack of outcomes beyond hospital discharge.
  
  
  CONCLUSIONS
  RARC is associated with lower parenteral nutrition use and fewer inpatient complications and deaths. However, lengths of stay are similar, and the robotic approach is significantly more costly.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Hua-yin
authors.initials: HY
authors.lastname: Yu
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007297:Inpatients; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010288:Parenteral Nutrition / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000628:therapy; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics / Q000191:economics*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*