A Contemporary Analysis of Utilization, Clinical Outcomes and Costs of Robotic-Assisted, Laparoscopic, and Open Partial Nephrectomy Using the National Inpatient Sample
Author(s)
Manisha Lin, MPH, PharmD, Mumbi E. Kimani, MA, PhD, Costas D. Lallas, MD, FACS, Raegan Davis, MA, Anushka Ghosh, BS, Patrick Moeller, BS, MPH, Scott W. Keith, PhD, Vittorio Maio, MS, MSPH, PharmD;
Thomas Jefferson University, Philadelphia, PA, USA
Thomas Jefferson University, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES: Partial nephrectomy is an increasingly popular approach for preserving renal function while treating small renal masses. This study compared current utilization, clinical outcomes, and costs of robotic-assisted partial nephrectomy (RAPN), laparoscopic partial nephrectomy (LAPN), and open surgery in renal cancer patients in the National Inpatient Sample (NIS).
METHODS: The 2016-2019 NIS database was used to identify renal cancer patients who underwent LAPN, RAPN, or open surgery, utilizing International Classification of Diseases, Tenth Revision (ICD-10) Clinical Modification (CM) and Procedure Coding System (PCS) codes. Baseline patient demographics and comorbidities, hospital characteristics, length of stay (LOS), complications, and associated costs, were summarized for each surgical approach. Regression analyses adjusted for patient and hospital covariates were conducted to compare the surgical types on perioperative complications, LOS, and hospital costs.
RESULTS: 89,290 weighted patients who underwent partial nephrectomy were identified (mean age: 59.4 years, 60.4% male, 68.9% white). Among these patients, 63.4% underwent RAPN, 14% underwent LAPN, and 22.6% underwent open surgery. Median hospital costs were lower for LAPN ($14,627 [$10,126, $21,549]) when compared to RAPN ($15,187 [$11,597, $20,325]) and open surgery ($15,364 [$11,433, $21,849]). Patients treated with RAPN and LAPN were less likely to experience perioperative complications compared to open surgery (RAPN: OR 0.48, 95% CI 0.43-0.55; LAPN: OR 0.51, 95% CI 0.43-0.61). Only RAPN patients were less likely to experience blood transfusion (OR 0.38, 95% CI 0.31-0.47), mortality (OR 0.24, 95% CI 0.10-0.58), and reduced LOS (OR 0.78, 95% CI 0.74-0.82). Hospital costs for RAPN and LAPN did not significantly differ from those for open surgery.
CONCLUSIONS: RAPN was the most utilized minimally invasive surgery approach for renal cancer patients. Compared to open surgery, RAPN was associated with superior clinical outcomes, whereas LAPN showed intermediate benefits. Further analyses are warranted to explore the cost-effectiveness of RAPN, LAPN and open surgery.
METHODS: The 2016-2019 NIS database was used to identify renal cancer patients who underwent LAPN, RAPN, or open surgery, utilizing International Classification of Diseases, Tenth Revision (ICD-10) Clinical Modification (CM) and Procedure Coding System (PCS) codes. Baseline patient demographics and comorbidities, hospital characteristics, length of stay (LOS), complications, and associated costs, were summarized for each surgical approach. Regression analyses adjusted for patient and hospital covariates were conducted to compare the surgical types on perioperative complications, LOS, and hospital costs.
RESULTS: 89,290 weighted patients who underwent partial nephrectomy were identified (mean age: 59.4 years, 60.4% male, 68.9% white). Among these patients, 63.4% underwent RAPN, 14% underwent LAPN, and 22.6% underwent open surgery. Median hospital costs were lower for LAPN ($14,627 [$10,126, $21,549]) when compared to RAPN ($15,187 [$11,597, $20,325]) and open surgery ($15,364 [$11,433, $21,849]). Patients treated with RAPN and LAPN were less likely to experience perioperative complications compared to open surgery (RAPN: OR 0.48, 95% CI 0.43-0.55; LAPN: OR 0.51, 95% CI 0.43-0.61). Only RAPN patients were less likely to experience blood transfusion (OR 0.38, 95% CI 0.31-0.47), mortality (OR 0.24, 95% CI 0.10-0.58), and reduced LOS (OR 0.78, 95% CI 0.74-0.82). Hospital costs for RAPN and LAPN did not significantly differ from those for open surgery.
CONCLUSIONS: RAPN was the most utilized minimally invasive surgery approach for renal cancer patients. Compared to open surgery, RAPN was associated with superior clinical outcomes, whereas LAPN showed intermediate benefits. Further analyses are warranted to explore the cost-effectiveness of RAPN, LAPN and open surgery.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO110
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders, STA: Surgery