MP38-20 HEALTH CARE COSTS AND HOSPITAL READMISSIONS FOR RADICAL CYSTECTOMY FOR BLADDER CANCER BY SURGICAL APPROACH AND DIVERSION (2021)

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP38)1 Sep 2021MP38-20 HEALTH CARE COSTS AND HOSPITAL READMISSIONS FOR RADICAL CYSTECTOMY FOR BLADDER CANCER BY SURGICAL APPROACH AND DIVERSION Miguel Rodriguez-Homs, Jeffrey Morrison, Badrinath Konety, Boris Gershman, Michael Bronsert, Alexander Kutikov, Janet Kukreja, Rodrigo Rodrigues Pessoa, and Simon Kim Miguel Rodriguez-HomsMiguel Rodriguez-Homs More articles by this author , Jeffrey MorrisonJeffrey Morrison More articles by this author , Badrinath KonetyBadrinath Konety More articles by this author , Boris GershmanBoris Gershman More articles by this author , Michael BronsertMichael Bronsert More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Janet KukrejaJanet Kukreja More articles by this author , Rodrigo Rodrigues PessoaRodrigo Rodrigues Pessoa More articles by this author , and Simon KimSimon Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002053.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is associated with a high risk of postoperative complications and higher health care costs. Although robotic surgery has been initially shown to increase costs, readmission and health care costs attributable to surgical approach (robotic versus open) and type of diversion (ileal conduit {IC} versus neobladder {NB}) in the post-dissemination robotic era remain largely unknown. We aimed to assess the comparative outcomes of a large privately insured cohort of bladder cancer (BCa) patients by surgical approach and diversion. METHODS: Using the MarketScan database, we identified all patients diagnosed with BCa and underwent open or robotic RC and IC or NB from 2010 – 2015. The primary outcomes were index length of stay (LOS), 90-day readmission, and total health care costs. We used multivariable logistic regression and generalized estimating equations to assess for 90-day readmission and health care costs, respectively, adjusting for age, gender and Elixhauser comorbidity. RESULTS: During the study interval, a majority of patients underwent open RC with IC (56.7%; n = 1680) followed by open RC with NB (22.7%; n=672), robotic RC with IC (17.4%; n=516), and robotic RC with NB (3.1%; n=93). Patients had lower LOS when undergoing robotic RC with IC (7.4; SD: 4.5) compared to open RC with IC (8.7 days, SD: 7.0), open RC with NB (8.9 days; SD: 6.3), and robotic RC with NB (8.6 days; SD: 4.8). On multivariable analysis, patients had higher odds of 90-day readmission for open RC with NB (OR: 1.5; 95% CI: 1.3–1.9), robotic RC with IC (OR: 1.3; 95% CI: 1.0 – 1.6), and robotic RC with NB (OR 1.8; 95% CI: 1.1–2.7) compared to open RC with IC. Similarly, open RC with IC was associated with significantly lower 90-day adjusted costs ($65,761.2; 95% CI: $65,078.4–$66,444.0) compared to robotic RC with IC ($71,671.4; 95% CI: $70,460.1–$72,882.7), robotic RC with NB ($76,502.0; 95% CI: $73,277.0–$79,726.9), and open RC with NB ($76,252.6; 95% CI: $75,139.7–$77,365.5). CONCLUSIONS: In this population-based cohort of privately insured patients undergoing RC, neobladder diversion was associated with higher risk of readmission and health care costs. Increased attention in reducing readmissions and perioperative care for patients undergoing NB may substantially reduce costs. Source of Funding: Schramm Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e702-e703 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miguel Rodriguez-Homs More articles by this author Jeffrey Morrison More articles by this author Badrinath Konety More articles by this author Boris Gershman More articles by this author Michael Bronsert More articles by this author Alexander Kutikov More articles by this author Janet Kukreja More articles by this author Rodrigo Rodrigues Pessoa More articles by this author Simon Kim More articles by this author Expand All Advertisement PDF downloadLoading ...