1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
J Endourol. 2019 Jun;33(6):438-447. doi: 10.1089/end.2018.0840.
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 nonrobot-assisted MSUPs. Within the National Inpatient Sample database (2009-2015), we identified patients who underwent robot-assisted 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 -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. 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%, < 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 < 0.05). Conversely, no statistically significant difference in the mean THCGs was reported between robot-assisted and nonrobot-assisted PN (+$367, > 0.05). Finally, the annual observed mean THCGs linearly decreased for all robot-assisted MSUPs during the study period. 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 nonrobot-assisted PN.
机器人辅助在所有主要的外科泌尿肿瘤学程序（MSUP）中越来越重要。然而，当代分析表明，机器人辅助手术相关的总住院费用（THCG）超过了开放手术。基于对机器人辅助手术的日益熟悉，我们假设过去五年中 THCG 可能有所下降。因此，我们测试了机器人辅助非机器人辅助 MSUP 相关的当代趋势和 THCG。在国家住院患者样本数据库（2009-2015 年）中，我们确定了接受机器人辅助非机器人辅助（开放或腹腔镜）MSUP 的患者，包括根治性前列腺切除术（RP）、根治性肾切除术（RN）、部分肾切除术（PN）和根治性膀胱切除术（RC）。使用估计的年百分比变化（EAPC）分析评估机器人辅助 MSUP 的比率。根据机器人辅助或非机器人辅助方法，使用 t 检验检查总住院费用均值之间的统计学显着差异。最后，测试了总住院费用均值的年度变化的线性回归分析。在 128367 例 MSUP 中，有 47.7%是机器人辅助的。总体而言，2009 年至 2015 年间，MSUP 中机器人辅助手术的比例从 40.3%增加到 57.6%（EAPC：+6.3%，<0.001）。机器人辅助 RP、RN、PN 和 RC 的平均总住院费用分别为 13799 美元、18789 美元、16574 美元和 33575 美元。机器人辅助和非机器人辅助 MSUP 之间观察到的总住院费用均值差异分别为+1594 美元、+1592 美元和+1829 美元，用于 RP、RN 和 RC（均<0.05）。相反，在机器人辅助和非机器人辅助 PN 之间，总住院费用均值无统计学差异（+367 美元，>0.05）。最后，在研究期间，所有机器人辅助 MSUP 的总住院费用均值呈线性下降。2009 年至 2015 年间，机器人辅助 MSUP 的比例呈指数增长。尽管在此期间所有 MSUP 的总住院费用均值都显著下降，但机器人辅助 RP、RN 和 RC 的总住院费用仍高于各自的非机器人辅助对应物。相反，在机器人辅助和非机器人辅助 PN 之间，总住院费用均值没有差异。
