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Partial nephrectomy in frail patients: Benefits of robot-assisted surgery.

Authors :
Rosiello G
Palumbo C
Deuker M
Stolzenbach LF
Martin T
Tian Z
Larcher A
Capitanio U
Montorsi F
Shariat SF
Kapoor A
Saad F
Briganti A
Karakiewicz PI
Source :
Surgical oncology [Surg Oncol] 2021 Sep; Vol. 38, pp. 101588. Date of Electronic Publication: 2021 Apr 22.
Publication Year :
2021

Abstract

Background: To compare the effect of robot-assisted (RAPN) vs. open (OPN) partial nephrectomy on short-term postoperative outcomes and total hospital charges in frail patients with non-metastatic renal cell carcinoma (RCC).<br />Methods: Within the National Inpatient Sample database we identified 2745 RCC patients treated with either RAPN or OPN between 2008 and 2015, who met the Johns Hopkins Adjusted Clinical Groups frailty-defining indicator criteria. We examined the rates of RAPN vs. OPN over time. Moreover, we compared the effect of RAPN vs. OPN on short-term postoperative outcomes and total hospital charges. Time trends and multivariable logistic, Poisson and linear regression models were applied.<br />Results: Overall, 1109 (40.4%) frail patients were treated with RAPN. Rates of RAPN increased over time, from 16.3% to 54.7% (p < 0.001). Frail RAPN patients exhibited lower rates (all p < 0.001) of overall complications (35.3 vs. 48.3%), major complications (12.4 vs. 20.4%), blood transfusions (8.0 vs. 13.5%), non-home-based discharge (9.6 vs. 15.2%), shorter length of stay (3 vs. 4 days), but higher total hospital charges ($50,060 vs. $45,699). Moreover, RAPN independently predicted (all p < 0.001) lower risk of overall complications (OR: 0.58), major complications (OR: 0.55), blood transfusions (OR: 0.60) and non-home-based discharge (OR: 0.51), as well as shorter LOS (RR: 0.77) but also higher total hospital charges (RR: +$7682), relative to OPN.<br />Conclusions: In frail patients, RAPN is associated with lower rates of short-term postoperative complications, blood transfusions and non-home-based discharge, as well as with shorter LOS than OPN. However, RAPN use also results in higher total hospital charges.<br /> (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1879-3320
Volume :
38
Database :
MEDLINE
Journal :
Surgical oncology
Publication Type :
Academic Journal
Accession number :
33945961
Full Text :
https://doi.org/10.1016/j.suronc.2021.101588