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Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014)
INTRODUCTION: Radical cystectomy (RC) is a complex procedure with high perioperative morbidity. In an effort to reduce complications, robotic-assisted RC (RARC) has been adopted as a minimally invasive alternative to the open approach (ORC). Herein, we examine post-operative outcomes of the two surg...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Polish Urological Association
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848836/ https://www.ncbi.nlm.nih.gov/pubmed/33552567 http://dx.doi.org/10.5173/ceju.2020.0230 |
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author | Harb-De la Rosa, Alfredo Garcia-Castaneda, Jenny Hsu, Chiu-Hsieh Zeng, Jiping Batai, Ken Lee, Benjamin R. Chipollini, Juan |
author_facet | Harb-De la Rosa, Alfredo Garcia-Castaneda, Jenny Hsu, Chiu-Hsieh Zeng, Jiping Batai, Ken Lee, Benjamin R. Chipollini, Juan |
author_sort | Harb-De la Rosa, Alfredo |
collection | PubMed |
description | INTRODUCTION: Radical cystectomy (RC) is a complex procedure with high perioperative morbidity. In an effort to reduce complications, robotic-assisted RC (RARC) has been adopted as a minimally invasive alternative to the open approach (ORC). Herein, we examine post-operative outcomes of the two surgical approaches in the United States (US) using a large all-payer database. MATERIAL AND METHODS: Using International Classification of Disease, ninth revision (ICD-9) codes, patient who underwent RC were captured from National Inpatient Sample (2008–2014). ICD-9 diagnosis and procedure codes were used to identify post-operative complications. Trends in the utilization of RARC were analyzed. Logistic and log-linear regression accounting for hospital sample weights and sampling years were performed to analyze outcomes after adjustment of pertinent covariates. RESULTS: Of 11,189 patients, 14% underwent RARC. RARC was performed in more teaching hospitals, male patients, those with private insurance, and lower comorbidity score. Performance of RARC steadily increased over the study period (p <0.01). In the last year of the study, 22.8% of cases performed robotically. The weighted average length-of-stay were 10.4 and 8.79 days for ORC and RARC, respectively (p <0.01). In multivariable analyses, RARC was associated with decreased blood transfusion, parenteral nutrition, pneumonia, surgical-site infection, wound and respiratory complications (all, p <0.05). No significant differences were found for in-hospital mortality, cardiac, genitourinary, and vascular complications. CONCLUSIONS: Performance of RARC has significantly increased in recent years. RARC appears safe and feasible for select patients. Earlier discharge and lower complications were noted for those undergoing RARC across different hospital systems nationwide. |
format | Online Article Text |
id | pubmed-7848836 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Polish Urological Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-78488362021-02-04 Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) Harb-De la Rosa, Alfredo Garcia-Castaneda, Jenny Hsu, Chiu-Hsieh Zeng, Jiping Batai, Ken Lee, Benjamin R. Chipollini, Juan Cent European J Urol Original Paper INTRODUCTION: Radical cystectomy (RC) is a complex procedure with high perioperative morbidity. In an effort to reduce complications, robotic-assisted RC (RARC) has been adopted as a minimally invasive alternative to the open approach (ORC). Herein, we examine post-operative outcomes of the two surgical approaches in the United States (US) using a large all-payer database. MATERIAL AND METHODS: Using International Classification of Disease, ninth revision (ICD-9) codes, patient who underwent RC were captured from National Inpatient Sample (2008–2014). ICD-9 diagnosis and procedure codes were used to identify post-operative complications. Trends in the utilization of RARC were analyzed. Logistic and log-linear regression accounting for hospital sample weights and sampling years were performed to analyze outcomes after adjustment of pertinent covariates. RESULTS: Of 11,189 patients, 14% underwent RARC. RARC was performed in more teaching hospitals, male patients, those with private insurance, and lower comorbidity score. Performance of RARC steadily increased over the study period (p <0.01). In the last year of the study, 22.8% of cases performed robotically. The weighted average length-of-stay were 10.4 and 8.79 days for ORC and RARC, respectively (p <0.01). In multivariable analyses, RARC was associated with decreased blood transfusion, parenteral nutrition, pneumonia, surgical-site infection, wound and respiratory complications (all, p <0.05). No significant differences were found for in-hospital mortality, cardiac, genitourinary, and vascular complications. CONCLUSIONS: Performance of RARC has significantly increased in recent years. RARC appears safe and feasible for select patients. Earlier discharge and lower complications were noted for those undergoing RARC across different hospital systems nationwide. Polish Urological Association 2020-11-04 2020 /pmc/articles/PMC7848836/ /pubmed/33552567 http://dx.doi.org/10.5173/ceju.2020.0230 Text en Copyright by Polish Urological Association http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original Paper Harb-De la Rosa, Alfredo Garcia-Castaneda, Jenny Hsu, Chiu-Hsieh Zeng, Jiping Batai, Ken Lee, Benjamin R. Chipollini, Juan Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
title | Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
title_full | Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
title_fullStr | Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
title_full_unstemmed | Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
title_short | Perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
title_sort | perioperative outcomes of open vs. robotic radical cystectomy: a nationwide comparative analysis (2008–2014) |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848836/ https://www.ncbi.nlm.nih.gov/pubmed/33552567 http://dx.doi.org/10.5173/ceju.2020.0230 |
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