Presented by: Francesco Ditonno
Rush university medical center

Introduction

The existing literature on nephroureterectomy (NU) primarily relies on studies conducted at single institutions, which typically report outcomes from experienced surgeons at high-volume centers and teaching hospitals. However, it remains unclear whether similar outcomes can be reproduced at a broader national level. Our primary objective was to investigate overall complication rates among open and robotic/lap partial nephroureterectomy, including impact of social determinants of health (SDOH) on postoperative outcomes.

Materials

Patients who underwent open and robotic/lap NU between 2011 and 2021 were retrospectively analyzed by using PearlDiver-Mariner, an all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes were used to identify the type of surgical operation, patient’s characteristics, postoperative complications and SDOH. Outcomes were compared using multivariable regression models.

Results

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Overall, 15,240 patients underwent open (n= 7,675) and robotic/lap (n= 7,565) nephroureterectomy. The 60-day postoperative complication rate was 23% for open and 19% for robotic approach. Approximately 5% and 9% of patients reported at least one SDOH at baseline for open and robotic/lap NU, respectively. SDOH were associated with slightly higher odds of postoperative complications (Open= OR:1.09, 95% CI:0.84-1.40; Robot/Lap = OR:1.17, 95% CI:0.95-1.43). Open approach showed a significantly higher risk of postoperative complications (OR:1.33, 95% CI:1.20-1.48) compared to the minimally invasive approach. Utilization of nephroureterectomy outlined opposite timeline trends when comparing open to robotic/lap approach, from 57% in 2011 to 13% in 2021 (p = 0.05) and from 24% to 35% (p = 0.05), respectively. There were not significant differences in terms of insurance plane’s adoption between the two groups.

Conclusion

Contemporary trends are showing a shift towards minimally invasive nephroureterectomy, which is gradually replacing the open counterpart, due to a less invasiveness and lower complication rates. SDOH seems to have slight impact on postoperative outcomes.

Funding

None

Co-Authors

Antonio Franco,
Rush university medical center

Morgan R. Sturgis,
Rush university medical center

Celeste Manfredi,
Rush university medical center

Daniel Roadman,
Rush university medical center

Jamie Yoon,
Rush university medical center

Adan Z Becerra,
Rush university medical center

Srinivas Vourganti,
Rush university medical center

Ephrem O Olweny,
Rush university medical center

Riccardo Autorino,
Rush university medical center