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Population-based analysis of cost and peri-operative outcomes between open and robotic primary retroperitoneal lymph node dissection for germ cell tumors

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Abstract

Purpose

To compare perioperative outcomes and perform the first cost analysis between open retroperitoneal lymph node dissection (O-RPLND) and Robotic-RPLND (R-RPLND) using a national all-payer inpatient care database.

Methods

Nationwide Inpatient Sample (NIS) was queried between 2013–2016 for primary RPLND and germ cell tumor. We compared cost, length of stay (LOS), and complications between O-RPLND and R-RPLND. Linear regression plots identified point of cost equivalence between R-RPLND and O-RPLND. A multivariable linear regression model was generated to analyze predictors of cost.

Results

44 cases of R-RPLND and 319 cases of O-RPLND were identified. R-RPLND was associated with lower rate of complications (0% vs. 16.6%, p < 0.01) and shorter LOS [Median (IQR): 1.5 (1–3) days vs. 4 (3–6) days, p < 0.01]. Rates of ileus, genitourinary complications, and transfusions were lower with R-RPLND, but did not reach significance. On multivariable analysis, robotic approach independently contributed $4457, while each day of hospitalization contributed to an additional $2,431 to the overall model of cost. Linear regression plots determined point of cost equivalence between an R-RPLND staying a mean of 2 days was 4–5 days for O-RPLND, supporting the multivariable analysis. Total hospitalization cost was equivalent between R-RPLND and O-RPLND [Median (IQR): $15,681($12,735–$21,596) vs $16,718($11,799–$24,403), p = 0.48]—suggesting that the cost equivalency of R-RPLND is, at least in part, attributable to shorter LOS.

Conclusion

While O-RPLND remains the gold standard and this study is limited by selection bias of a robotic approach to RPLND, our findings suggest primary R-RPLND may represent a cost-equivalent option with decreased hospital LOS in select cases.

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Data availability

All NIS data are available for purchase through the Healthcare Cost and Utilization Project at hcup-us.ahrq.gov.

Code availability

All data aggregation and statistical analysis were performed using Stata®, version 13.0 (StataCorp., College Station, TX, USA).

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Authors and Affiliations

  1. Department of Urology, University of Texas Southwestern, 2001 Inwood Road, 4th Floor, WBCE3, Dallas, TX, 75390, USA

    Raj Bhanvadia, Caleb Ashbrook, Aditya Bagrodia, Yair Lotan, Vitaly Margulis & Solomon Woldu

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  1. Raj Bhanvadia
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  2. Caleb Ashbrook
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  3. Aditya Bagrodia
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  4. Yair Lotan
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  5. Vitaly Margulis
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Contributions

As corresponding author, I certify that all authors have made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. All authors have substantially contributed to drafting the work or revising it critically for important intellectual content. SW: senior Author, project development, protocol development, data collection, investigation, supervision, manuscript writing—review and editing. RB: project development, data collection, investigation, data analysis, protocol development, manuscript writing—original draft. CA: data collection, protocol development, manuscript writing—original draft. YL: manuscript writing—review and editing. AB: manuscript writing—review and editing, protocol development. VM: manuscript writing—review and editing.

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Correspondence to Raj Bhanvadia.

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Bhanvadia, R., Ashbrook, C., Bagrodia, A. et al. Population-based analysis of cost and peri-operative outcomes between open and robotic primary retroperitoneal lymph node dissection for germ cell tumors. World J Urol 39, 1977–1984 (2021). https://doi.org/10.1007/s00345-020-03403-9

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  • DOI: https://doi.org/10.1007/s00345-020-03403-9

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