Inpatient outcomes of radical Nephroureterectomy (NU) for Upper Tract Urothelial Cancer (UTUC), with trends in utilization and impact of robotic surgery – National Inpatient Sample (NIS) analysis

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Conference Proceeding

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Eur Urol


Introduction & Objectives: Our primary aim was to evaluate the inpatient morbidity, mortality, and cost of radical NU for UTUC. We also aimed to evaluate the trends in utilization of robotic surgery for this procedure, and to assess the difference in outcomes between robotic NU and open NU in terms of the above outcomes from within the NIS.

Materials & Methods: We focused on 9581 records of adult patients with nonmetastatic UTUC undergoing radical NU from 2003-14, representing an estimated 47204 NUs performed in the US during this period. Data after 2014 was excluded due to International Classification of Diseases (ICD) coding change in 2015. ICD-9 code for robotics was introduced in 2008, so data before 2008 was not used when comparing surgical approaches. ICD-9 codes were used to define complications. Complex-survey procedures were used to study descriptive characteristics, and outcomes of patients undergoing NU. Cost of admission was inflation-adjusted to 2014 US dollars.

Results: Overall, the median age of the patients was 72 (IQR 63-79) years. 22974 (49%) patients had a Charlson comorbidity index of 3 or more. 33693 (71%) patients had Medicare/Medicaid insurance. 14692 (31%) patients had complications, with 6814 (14%) having major complications. Significant trend towards utilization of robotic approach was seen during the study period. Overall, 4635 NUs were performed robotically: accounting for 33% of NUs in 2014. Table 1 shows the outcomes after stratification for approach. Robotic surgery was associated with significantly lower rate of any complications 962 (21%) vs 7675 (33%) for open; p <0.001. This was also true for in hospital mortality (0.3% vs 1.2%; p 0.02), and major complications (10% vs 19%; p<0.001).

Conclusions: Nephroureterectomy is associated with a high inpatient morbidity and mortality. There is increasing utilization of robotic approach in the US. Robotic surgery is associated with lower morbidity and in hospital mortality in these patients. Table: Descriptive statistics and outcomes of radical NU for upper tract urothelial carcinoma in 47204 records from the National Inpatient sample from 2008-2014, stratified by surgical approach. IQR: Interquartile range; NU: Nephroureterectomy. *ICD code for robotics was introduced in 2008. Therefore, for comparison between surgical approaches, years before 2008 were excluded.



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