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Trends in utilisation, perioperative outcomes, and costs of nephroureterectomies in the management of upper tract urothelial carcinoma: a 10-year population-based analysis BJU INTERNATIONAL Tinay, I., Gelpi-Hammerschmidt, F., Leow, J. J., Allard, C. B., Rodriguez, D., Wang, Y., Chung, B. I., Chang, S. L. 2016; 117 (6): 954-960

Abstract

To perform a population-based study to evaluate contemporary utilization trends, morbidity and costs associated with nephroureterectomies (NU). Contemporary data for NU are largely derived from single academic institution series describing the experience of high-volume surgeons. It is unclear if the same favorable results occur on a national level.Using the Premier Hospital Database, we captured patients undergoing a NU with diagnoses of renal pelvis or ureteral neoplasms from 2004 to 2013. We fitted regression models, adjusting for clustering by hospitals and survey weighting to evaluate 90-day postoperative complications, operating-room-time (OT), prolonged length-of-stay (pLOS) and direct hospital costs among open, laparoscopic (LNU) and robotic (RNU) approaches.After applying sampling and propensity weights we derived a final study cohort of 17,254 ONU, 13,317 LNU and 3,774 RNU for UTUC in the US between 2004 and 2013. During that period, minimally invasive NU (miNU) increased from 36%-to-54% while the total number of NUs decreased by nearly 20%. No differences were noted in perioperative outcomes between three surgical approaches, including when the analysis was restricted to highest-volume hospitals and highest-volume surgeons. OT was longer for LNU and RNU (p<0.001), where the pLOS rates were decreased for LNU and RNU (p <0.001). Adjusted 90-day median direct-hospital-costs were higher for LNU and RNU (p<0.001), which disappear when adjusting for the highest-volume groups except in RNUs performed by high-volume surgeons.During this contemporary 10-year study, miNU is replacing open surgery for UTUC with a recent surge in RNU, along with a concurrent reduction in total NUs performed. Despite not being associated with a clinically significant improvement in perioperative outcomes, the costs for miNU were consistently higher. However, higher hospital volumes suggest a potential cost containment strategy when performing miNUs. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/bju.13375

View details for Web of Science ID 000376009800021

View details for PubMedID 26573216