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National trends in the utilization of robotic-assisted radical cystectomy: an analysis using the Nationwide Inpatient Sample.
- Source :
-
Urologic oncology [Urol Oncol] 2014 Aug; Vol. 32 (6), pp. 785-90. Date of Electronic Publication: 2014 May 23. - Publication Year :
- 2014
-
Abstract
- Objectives: To determine temporal and regional trends in utilization of robotic-assisted radical cystectomy (RARC) in the United States and to explore factors associated with utilization of robotic assistance.<br />Materials and Methods: Using 2009 to 2011 data from the Nationwide Inpatient Sample, we identified radical cystectomy cases that were performed using either open or robotic assistance and applied Nationwide Inpatient Sample discharge weights to determine national incidence. Univariable and multivariable logistic regressions were performed to assess regional trends and characteristics associated with having RARC. Descriptive analysis was performed using the chi-square test, the Student t test, and the Mann-Whitney U test.<br />Results: Of the 29,719 radical cystectomy patients, 3,733 were RARC (12.6%). Although there was no change in the proportion of RARC performed annually (P = 0.702). Length of stay was 1 day longer for open cystectomy than RARC (P<0.001). On multivariate regression, patients whose primary payer was Medicaid were less likely than private insurance patients to undergo RARC (odds ratio = 0.60, P = 0.074). Additionally, patients in the south were at 50% reduced odds of undergoing RARC (odds ratio = 0.49, P = 0.044). Median hospital costs were $5,000 greater for RARC (P<0.001).<br />Conclusions: Regional variation in utilization should be monitored to ensure equal access to new technology and to assess potential overuse of new technology. Although RARC is associated with higher median hospital costs, further studies to assess its benefits are warranted.<br /> (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Chi-Square Distribution
Cystectomy economics
Cystectomy statistics & numerical data
Female
Health Care Costs statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Public Health economics
Public Health trends
United States
Cystectomy methods
Inpatients statistics & numerical data
Robotics
Urinary Bladder Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2496
- Volume :
- 32
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Urologic oncology
- Publication Type :
- Academic Journal
- Accession number :
- 24863014
- Full Text :
- https://doi.org/10.1016/j.urolonc.2014.04.007