Researchers aimed to compare surgical outcomes and hospital expenses for a population-based cohort of patients with bladder cancer, stratifying by treatment strategy. Individuals with bladder cancer who underwent open or robotic radical cystectomy with ileal conduit or neobladder between 2010 and 2015 were found in a national database of patients with private health insurance. Length of stay, readmissions, and total health care costs at 90 days post-surgery were the key outcomes.
To evaluate the likelihood of a patient being readmitted within 90 days and the associated healthcare expenses, they employed multivariable logistic regression and generalized estimating equations, respectively. Out of 1,680 patients, 56.7% had an open radical cystectomy with an ileal conduit, 22.7% (672) had an open radical cystectomy with a neobladder, 17.4% (516) had a robotic radical cystectomy with an ileal conduit, and 3.1% (93) had a robotic radical cystectomy with a neobladder. Patients who underwent open radical cystectomy with neobladder (OR: 1.36; P =.002) or robotic radical cystectomy with neobladder (OR: 1.60; P =.03) were more likely to be readmitted within 90 days after surgery compared to those who underwent open radical cystectomy with an ileal conduit.
In addition, they found that after controlling for patient covariates, the total adjusted costs of care for 90 days following open radical cystectomy with ileal conduit ($67,915) and open radical cystectomy with neobladder ($67,371) were lower than those following robotic radical cystectomy with ileal conduit ($70,677) and neobladder ($70,818; P<.05). Investigators found that neobladder diversion increased the risk of readmission within 90 days, while robotic surgery raised the cost of care within the same time frame.