Comparative Analysis of Robotic-Assisted, Laparoscopic, and Open Radical Nephrectomy: Trends, Costs, and Clinical Outcomes
Author(s)
Daniel Y. Huang, PharmD1, Costas D. Lallas, MD, FACS2, Raegan Davis, MA1, Anushka Ghosh, MD3, Patrick Moeller, MPH1, Scott Keith, PhD4, Inkyu Kim, PhD1, Vittorio Maio, MS, MSPH, PharmD1.
1College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA, 2Department of Urology, Sidney Kimmel Cancer Center, Philadelphia, PA, USA, 3Sidney Kimmel Medical Colleage, Philadelphia, PA, USA, 4Division of Biostatistics and Bioinformatics, Sidney Kimmel Medical College, Philadelphia, PA, USA.
1College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA, 2Department of Urology, Sidney Kimmel Cancer Center, Philadelphia, PA, USA, 3Sidney Kimmel Medical Colleage, Philadelphia, PA, USA, 4Division of Biostatistics and Bioinformatics, Sidney Kimmel Medical College, Philadelphia, PA, USA.
Presentation Documents
OBJECTIVES: Radical nephrectomy is a standard treatment for renal cell carcinoma. Minimally invasive techniques, including laparoscopic (LARN) and robotic-assisted radical nephrectomy (RARN), have gained popularity over open radical nephrectomy (ORN). This study aimed to evaluate trends in the use of RARN, LARN, and ORN, and compare their associated costs, clinical complications, and mortality rates in patients with renal cancer.
METHODS: Patients undergoing radical nephrectomy for renal cancer between 2016 and 2019 were identified using the National Inpatient Sample (NIS) database. Procedures were categorized as RARN, LARN, or ORN based on ICD-10-CM and Procedure Coding System codes. Baseline patient demographics, comorbidities, hospital characteristics, length of stay (LOS), complications, and associated costs, were analyzed. Trends in utilization of the three surgical approaches were calculated. Multiple linear and logistic regression analyses, controlling for patient and hospital factors, were used to association of surgical approach with perioperative complication rates, LOS, and hospital costs.
RESULTS: Among 155,910 weighted patients who underwent radical nephrectomy from 2016 to 2019, the use of RARN increased from 21.9% to 29.9%, while LARN decreased from 45.6% to 35.6%. RARN was more frequently used for older patients and those with comorbidities. Median hospital costs were lower for LARN ($13,934) when compared to RARN ($16,765) and ORN ($17,790). Both RARN and LARN were associated with significantly lower risk of perioperative complications (RARN: OR 0.44, 95% CI 0.39-0.48; LARN: OR 0.43, 95% CI 0.40-0.47), blood transfusion (RARN: OR 0.28, 95% CI 0.24-0.32; LARN: OR 0.24, 95% CI 0.21-0.27) and mortality (RARN: OR 0.08, 95% CI 0.05-0.14; LARN: OR 0.10, 95% CI 0.07-0.15) compared to ORN. LOS and hospital costs were also significantly lower for RARN and LARN compared to ORN.
CONCLUSIONS: RARN and LARN demonstrated clinical advantages over ORN. Further research is necessary to evaluate the cost-effectiveness and long-term benefits of RARN and LARN compared to ORN.
METHODS: Patients undergoing radical nephrectomy for renal cancer between 2016 and 2019 were identified using the National Inpatient Sample (NIS) database. Procedures were categorized as RARN, LARN, or ORN based on ICD-10-CM and Procedure Coding System codes. Baseline patient demographics, comorbidities, hospital characteristics, length of stay (LOS), complications, and associated costs, were analyzed. Trends in utilization of the three surgical approaches were calculated. Multiple linear and logistic regression analyses, controlling for patient and hospital factors, were used to association of surgical approach with perioperative complication rates, LOS, and hospital costs.
RESULTS: Among 155,910 weighted patients who underwent radical nephrectomy from 2016 to 2019, the use of RARN increased from 21.9% to 29.9%, while LARN decreased from 45.6% to 35.6%. RARN was more frequently used for older patients and those with comorbidities. Median hospital costs were lower for LARN ($13,934) when compared to RARN ($16,765) and ORN ($17,790). Both RARN and LARN were associated with significantly lower risk of perioperative complications (RARN: OR 0.44, 95% CI 0.39-0.48; LARN: OR 0.43, 95% CI 0.40-0.47), blood transfusion (RARN: OR 0.28, 95% CI 0.24-0.32; LARN: OR 0.24, 95% CI 0.21-0.27) and mortality (RARN: OR 0.08, 95% CI 0.05-0.14; LARN: OR 0.10, 95% CI 0.07-0.15) compared to ORN. LOS and hospital costs were also significantly lower for RARN and LARN compared to ORN.
CONCLUSIONS: RARN and LARN demonstrated clinical advantages over ORN. Further research is necessary to evaluate the cost-effectiveness and long-term benefits of RARN and LARN compared to ORN.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO11
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, SDC: Urinary/Kidney Disorders