In a retrospective cohort study reported in JAMA Network Open, Okhawere et al found that minimally invasive surgery was associated with similar or reduced total expenditures vs open surgery during the first year after partial or radical nephrectomy for kidney cancer.
Study Details
The study involved data on 5,104 patients aged 18 to 64 years who underwent nephrectomy between 2013 and 2018 identified from a U.S. commercial claims database (IBM MarketScan Research Database). Patients had to be continuously insured for 180 days before and 365 days after surgery. Among the 5,104 patients, 2,639 underwent partial nephrectomy, including 2,008 who had minimally invasive surgery vs 631 who had open surgery, and 2,465 had radical nephrectomy, including 1,816 who had minimally invasive surgery vs 649 who had open surgery. All expenditures were adjusted for inflation to 2018 U.S. dollars.
Key Findings
Patients who underwent minimally invasive surgery had lower index hospital length of stay compared with open surgery: mean stays were 2.45 days vs 3.78 days among patients undergoing partial nephrectomy (P < .001) and 2.82 days vs 4.62 days among those undergoing radical nephrectomy (P < .001).
Mean index expenditures were lower with minimally invasive surgery vs open surgery for patients undergoing radical nephrectomy ($28,999 vs $31,977, P < .001) and higher with minimally invasive surgery for those undergoing partial nephrectomy ($30,380 vs $27,480, P < .001).
Patients undergoing minimally invasive surgery had lower 1-year postdischarge readmission rates after both partial nephrectomy (15.1% vs 21.5%; odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.52–0.82, P < .001) and radical nephrectomy (15.6% vs 18.9%; OR = 0.79, 95% CI = 0.63–1.00, P = .05). Patients undergoing minimally invasive surgery had fewer hospital outpatient visits after both partial nephrectomy (mean = 4.69 vs 5.25, P = .01) and radical nephrectomy (mean = 5.50 vs 6.71, P < .001).
For radical nephrectomy, minimally invasive surgery was associated with 1.47 fewer missed workdays per patient postdischarge (95% CI = 0.57–2.38 days, P = .001). No significant difference was observed for partial nephrectomy.
Total cumulative expenditures with minimally invasive surgery vs open surgery were similar among patients undergoing partial nephrectomy (mean difference = $331, 95% CI = –$3,250 to $3,912, P = .85) and lower among patients undergoing radical nephrectomy (mean difference = –$11,265, 95% CI = –$17,065 to –$5,465, P < .001).
The investigators concluded, “In this cohort study, minimally invasive surgery was associated with lower or similar total cumulative expenditure than open surgery in the period 1 year after discharge from the index surgery. These findings suggest that downstream expenditures and resource utilization should be considered when evaluating surgical approach for nephrectomy.”
Ketan K. Badani, MD, of the Department of Urology, Icahn School of Medicine at Mount Sinai, is the corresponding author for the JAMA Network Open article.
Disclosure: Intuitive Surgical Inc funded access to the IBM MarketScan Research Database. For full disclosures of the study authors, visit jamanetwork.com.
