Two-year resource utilization of open vs. robot-assisted radical cystectomy: Results from optum's de-identified clinformatics® data mart database

Purpose: Despite increasing adoption of robotic radical cystectomy (RRC), its cost-effectiveness remains in question. Therefore, we aimed to compare 2-year resource utilization (RU) between RRC and open radical cystectomy (ORC). Methods: Queried from Optum's de-identified Clinformatics® Data Mart Database, patients diagnosed with bladder cancer who underwent radical cystectomy were identified between 2014 and 2017. Patients with ≥2 years of continuous enrollment were stratified by open and robotic approach. RU was evaluated from incident hospitalization costs and total standardized costs over 2 years for each subsequent inpatient/outpatient visit. Multivariate generalized linear regression (MGLR) was used to determine the impact of surgical approach on subsequent RU. Results: About 2,373 patients were identified. Of patients with continuous enrollment for ≥2 years (N = 1353), 798 (59%) underwent RRC and 555 (41%) underwent ORC. RRC was associated with lower RU than ORC, ($65,188.02 vs. $80,375.90, P < 0.0001) and lower inpatient costs for incident hospitalization ($29,142 vs. $42,329, P < 0.001). RRC, versus ORC, demonstrated shorter median length of hospital stay (5 vs. 7 days, P < 0.0001), and was associated with lower rates of acute kidney failure (3% vs. 5%, P = 0.007), ileus (2% vs. 5%, P = 0.005) and blood transfusions (≤ 2% vs. 6%, P < 0.001). MGLR demonstrated that robotic approach independently reduced total cost (β 0.84, CI 0.77–0.93, P < 0.001). Conclusions: RRC is associated with reduced 2-year RU and incident hospitalization costs compared to ORC. Robotic technique was independently associated with lower total costs. While granular cost metric details are limited, the reduced RU with RRC represents a novel assessment of reduced postoperative morbidity.