Di Bello Francesco, Rodriguez Penaranda Natali, Marmiroli Andrea, Longoni Mattia, Falkenbach Fabian, Le Quynh Chi, Tian Zhe, Goyal Jordan A, Collà Ruvolo Claudia, Califano Gianluigi, Creta Massimiliano, Saad Fred, Shariat Shahrokh F, Puliatti Stefano, De Cobelli Ottavio, Briganti Alberto, Graefen Markus, Chun Felix H K, Longo Nicola, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
Ann Surg Oncol. 2025 May 2. doi: 10.1245/s10434-025-17398-3.
The aim of this work is to quantify the magnitude of improvement in in-hospital outcomes between historical and contemporary robot-assisted partial nephrectomy (RPN) versus historical and contemporary open PN (OPN).
Within the Nationwide Inpatient Sample (2010-2019), we identified patients who underwent RPN and OPN. Multivariable logistic regression models were fit.
Historical (2010-2014) versus contemporary (2015-2019) proportions were 39% (n = 5,897) versus 61% (n = 9168) for RPN and 59% (n = 7289) versus 41% (n = 5,120) for OPN. Relative to historical, contemporary RPN patients exhibited significantly better in-hospital outcomes in 6 of 12 categories that ranged from-76% for intraoperative complications to-24% for length of stay (LOS) ≥ 75th percentile. Relative to historical, contemporary OPN patients also exhibited significantly better in-hospital outcomes in 7 of 12 categories that ranged from-76% for intraoperative complications to-23% for LOS ≥ 75th percentile. When historical RPN was compared with historical OPN, RPN in-hospital outcomes were better in 10 of 12 comparisons that ranged from-75% for LOS ≥ 75th percentile to-28% for perioperative bleeding. Similarly, when contemporary RPN was compared with contemporary OPN, RPN outcomes were better in 8 of 12 comparisons that ranged from-75% for LOS ≥ 75th percentile to-27% for postoperative complications.
The magnitude of improvement in in-hospital outcomes was more pronounced for contemporary versus historical OPN (seven improved categories) than for contemporary versus historical RPN (six improved categories). However, contemporary RPN outperformed contemporary OPN patients in eight in-hospital outcome categories.
本研究旨在量化历史对照与当代机器人辅助部分肾切除术（RPN）以及历史对照与当代开放性部分肾切除术（OPN）之间住院结局的改善程度。
在全国住院患者样本（2010 - 2019年）中，我们确定了接受RPN和OPN的患者。拟合多变量逻辑回归模型。
RPN的历史对照（2010 - 2014年）与当代对照（2015 - 2019年）比例分别为39%（n = 5897）与61%（n = 9168），OPN的比例分别为59%（n = 7289）与41%（n = 5120）。与历史对照相比，当代RPN患者在12个类别中的6个类别中表现出显著更好的住院结局，范围从术中并发症降低76%到住院时间（LOS）≥第75百分位数降低24%。与历史对照相比，当代OPN患者在12个类别中的7个类别中也表现出显著更好的住院结局，范围从术中并发症降低76%到LOS≥第75百分位数降低23%。当历史RPN与历史OPN进行比较时，RPN的住院结局在12项比较中的10项中更好，范围从LOS≥第75百分位数降低75%到围手术期出血降低28%。同样，当当代RPN与当代OPN进行比较时，RPN结局在12项比较中的8项中更好，范围从LOS≥第75百分位数降低75%到术后并发症降低27%。
与历史对照相比，当代OPN（7个改善类别）在住院结局方面的改善程度比当代RPN（6个改善类别）更为显著。然而，当代RPN在8个住院结局类别中优于当代OPN患者。
