Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission

The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n=149) or robotic (n=100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien-Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150cc, p<0.01), operative time (mean: 6.19 versus 6.85h, p<0.01), and length of stay (median: 7 versus 5 days, p<0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p<0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p=0.01; 52% versus 11%, p<0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p<0.01). Patients in the open group experienced more major complications (19% versus 10%, p=0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20-0.99, p=0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p<0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.