title: National trends in the utilization of robotic-assisted radical cystectomy: an analysis using the Nationwide Inpatient Sample.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN. Electronic address: mmonn@iupui.edu.
authors.forename: M Francesca
authors.initials: MF
authors.lastname: Monn
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: K Clint
authors.initials: KC
authors.lastname: Cary
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Hristos Z
authors.initials: HZ
authors.lastname: Kaimakliotis
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Flack
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Koch
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015653:Cystectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011634:Public Health / Q000191:economics / Q000639:trends; D012371:Robotics; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Radical cystectomy; Robotic assistance; Urothelial bladder cancer