Abstract: PD14-12
Sources of Funding: none

Introduction

Previous studies demonstrated higher initial hospitalization and 90-day hospital costs for minimally-invasive (MIRC) vs. open radical cystectomy (ORC). These studies were limited in that they were conducted with Medicare databases (>65 years-old) or private payer databases (<65 years-old). Therefore, our objective was to compare initial, 30-day, and 90-day follow-up hospital costs for patients undergoing MIRC vs. ORC in a nationally representative sample containing both Medicare and non-Medicare beneficiaries.

Methods

We queried the 2013 Nationwide Readmissions Database for bladder cancer patients undergoing RC. ICD-9 codes were used to determine surgical approach. Initial, 30-day, and 90-day hospital costs, length of stay (LOS), and complication rates were compared between MIRC and ORC patients. Multivariable linear regression was performed to determine if surgical approach was a significant predictor of 30-day and 90-day hospital costs after controlling for patient and hospital characteristics. Multivariable logistic regression was performed to compare the odds of 30-day and 90-day readmission between MIRC vs. ORC.

Results

In the cohort, 4918 ORCs and 1608 MIRCs were performed. The initial hospital costs were significantly higher for MIRC vs. ORC ($36970 vs. $32111, p=0.005). However, MIRC patients had a shorter LOS (8.9 vs. 10.6 days, p<0.001) and lower perioperative complication rate (37.3% vs. 43.2%, p=0.01) than ORC patients, respectively. Both 30-day ($4403 vs. $4571, p=0.8) and 90-day ($8013 vs. $8432, p=0.7) follow-up hospital costs were comparable for MIRC vs. ORC, respectively. After adjustment, there was still no significant difference in 30-day (βmirc=$-45 [95%CI: -1377,1287]) and 90-day (βmirc=$-222 [95%CI: -2441, 1997]) follow-up hospital costs between surgical approaches. In multivariable models, when comparing MIRC vs. ORC the odds of 30-day (OR=0.93 95%CI [0.63, 1.18]) and 90-day readmission (OR=1.01 95%CI [0.79, 1.29]) were comparable.

Conclusions

In this nationally representative study that includes both Medicare and non-Medicare patients, higher perioperative hospital costs for MIRC vs. ORC were driven by higher initial hospital costs as 30 and 90-day follow-up hospital costs were comparable. This higher initial cost of MIRC cannot be explained by LOS or complication rates, which are significantly lower for MIRC. As use of MIRC continues to expand, future studies are needed to identify potential areas to decrease costs associated with MIRC during the initial hospitalization.

Funding

none