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World Journal of Urology

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01-06-2021 | Ileus | Original Article

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

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

Published in: World Journal of Urology | Issue 6/2021

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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Title: Population-based analysis of cost and peri-operative outcomes between open and robotic primary retroperitoneal lymph node dissection for germ cell tumors
Authors: Raj Bhanvadia
Caleb Ashbrook
Aditya Bagrodia
Yair Lotan
Vitaly Margulis
Solomon Woldu
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Ileus
Lymphadenectomy
Published in: World Journal of Urology / Issue 6/2021
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03403-9

2024 ASCO Annual Meeting

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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