Login to Access Video or Poster Abstract: MP54-09
Sources of Funding: None

Introduction

The adoption of the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA) for robotic surgery requires a substantial financial investment by hospitals, acquisition of new surgical skills by surgeons, and demand from patients. The adoption rate and factors influencing the utilization of robotic surgery in the surgical management of patients with bladder cancer is currently unclear. Our aim was to evaluate trends in surgical approach and outcomes for radical cystectomy in the United States.

Methods

Using the Premier Healthcare Database, we captured all patients who underwent a RC (ICD-9 code 57.71) from 2003 to 2015. To identify robot-assisted (RARC) and laparoscopic RCs (LRC), we performed a detailed review of the hospital chargemaster. Multivariable regression analyses were performed after adjusting for survey weighting and clustering to evaluate factors associated with RARC use.

Results

Across the study period, there were a total of 71,844 RC (58,779 ORC, 3847 LRC, 9218 RARC). There is a gradual rise in the use of RARC from 0.1% in 2003 to 33.9% in 2015), overtaking the laparoscopic approach in 2009 (15.2% vs. LRC. Major (Clavien?3) and overall (Clavien?1) complication rates showed a rising trend up to 19.6% and 68.7% respectively in 2011 before plateauing (Figure 1). Factors significantly associated with RARC include older age (OR 1.01, p=0.03), male gender (OR 1.36, p=0.01), married (vs. non-married, OR 1.23, p=0.02), private insurance (vs. Medicare, OR 1.34, p<0.01), East North Central division (vs. South Atlantic, OR 2.13, p=0.03), Middle Atlantic (OR 2.99, p=0.01), hospital volume >90th percentile (>26/yr) (vs. ?90th percentile, OR 2.10, p=0.03) and later time period (vs. 2003-2006, OR for 2007-2010: 7.74, OR for 2011-2015: 18.99, both p<0.001). Patient with Charlson comorbidity index (CCI) ?2 (vs. CCI 0, OR 0.71, p<0.01) and at West South Central division (OR 0.36, p=0.04) were less likely to undergo RARC.

Conclusions

Currently, 1 in 3 RC cases are performed using robotic assistance. A variety of patient and hospital geographic characteristics appear to influence this increased utilization. This may be attributed to the acquisition of robotic surgical skills and familiarity with transperitoneal pelvic anatomy following the widespread use of robotic radical prostatectomy.

Funding

None