Hospital costs and length of stay related to robot-assisted versus open radical and partial nephrectomy for kidney cancer in the USA

There are scant national outcomes data for robot-assisted laparoscopic surgery. We assessed costs and length of stay (LOS) related to robot-assisted radical and partial nephrectomy in a nationally representative population database. We performed a cohort analysis of the US Nationwide Inpatient Sample database. Using ICD-9 procedure codes, we identified patients who underwent radical or partial nephrectomy for kidney cancer from October 2008 to December 2008. We excluded patients with non-robot-assisted laparoscopic procedures and those under age 18 years. We performed multivariate analyses of LOS and total hospital charges, adjusting for age, race, gender, Charlson comorbidity index, and teaching hospital status. Records of 2,242 patients were analyzed. On adjusted multivariate analysis, robot-assisted partial nephrectomy was associated with shorter LOS compared with open surgery (-2.0 days, P = 0.032). Robot-assisted radical nephrectomy was associated with shorter LOS compared with open surgery (-1.8 days, P = 0.077). There were no significant differences in total charges for robot-assisted compared with open surgery for either radical (P = 0.631) or partial (P = 0.713) nephrectomy. In this large, population-based analysis, robot-assisted radical and partial nephrectomy were associated with shorter LOS and equivalent hospital charges compared with their open surgery counterparts. These data suggest that, for renal surgery, diminished LOS offsets other hospital costs associated with robot-assisted procedures.