title: Minimally Invasive Versus Open Approach for Cystectomy: Trends in the Utilization and Demographic or Clinical Predictors Using the National Cancer Database.
abstract: OBJECTIVE
  To examine temporal national trends of operative approach for cystectomy and identify demographic or clinical predictive factors that influence choice of approach.
  
  
  METHODS
  We performed a retrospective cohort study of patients who underwent cystectomy for bladder cancer between 2010 and 2013 using the National Cancer Database. Approach was stratified by open vs minimally invasive (robotic or laparoscopic). Univariate Pearson chi-square and multivariate logistic regression analysis were used to assess the relationships between demographic and hospital factors and the receipt of minimally invasive or open surgical approach.
  
  
  RESULTS
  A total of 9439 patients met our inclusion criteria, of which 34.1% received a minimally invasive approach (MIA). Frequency of MIA increased from 26.3% in 2010 to 39.4% in 2013 (P < .0001). Univariate analysis identified statistically significant associations between year of diagnosis, sex, age, race, clinical T stage, insurance status, income, education, distance from hospital, facility type, geographic location, and facility cystectomy volume, and the choice of approach (all P < .01). On multivariate analysis, independent predictors of MIA included increasing year of diagnosis, male gender, lower clinical T stage, private insurance vs Medicaid, nonacademic vs academic program, northeastern geographic region, receipt of neoadjuvant chemotherapy, and lower cystectomy volume.
  
  
  CONCLUSIONS
  Utilization of MIA for cystectomy has increased nationally over the last several years likely due to increased surgeon familiarity with robotic laparoscopic pelvic surgery. Factors associated with MIA included male sex, locally confined disease, receipt of neoadjuvant chemotherapy, lower cystectomy volume centers, and nonacademic centers.
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK. Electronic address: Andrew-Bachman@ouhsc.edu.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Bachman
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Parker
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK.
authors.forename: Marshall D
authors.initials: MD
authors.lastname: Shaw
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Cross
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stratton
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.affiliation: University of Oklahoma Health Science Center, Oklahoma City, OK.
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Patel
mesh_terms: D000368:Aged; D000570:American Cancer Society; D015653:Cystectomy / Q000379:methods* / Q000639:trends*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D019060:Minimally Invasive Surgical Procedures / Q000639:trends*; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012955:Societies, Medical; D013997:Time Factors; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000601:surgery*