Presented by: Francesco Ditonno
Rush university medical center

Introduction

Our objective was to investigate overall complication rates among open and robotic partial nephrectomy (PN), including impact of social determinants of health (SDOH) on postoperative outcomes.

Materials

Patients who underwent partial nephrectomy 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, 65,325 patients underwent open (n= 23,377) and robotic (n= 41,948) PN. The 60-day postoperative complication rate was 14% for open and 9% for robotic approach. Approximately 16% and 11% of patients reported at least one SDOH at baseline for open and robotic PN, respectively. SDOH were associated with higher odds of postoperative complications (Open= OR:1.11, 95% CI:0.99-1.25; Robot = OR:1.31, 95% CI:1.18-1.46). Open approach showed a significantly higher risk of postoperative complications (OR:1.62, 95% CI:1.54-1.70) compared to the robotic approach. Utilization of PN outlined opposite timeline trends when comparing open to robotic approach, from 32% in 2011 to 26% (p = 0.05) in 2021 and from 24% to 34% (p = 0.05), respectively. There were no significant differences in terms of insurance plane’s adoption between the two groups.

Conclusion

Our findings confirm that robotic PN is gradually replacing open PN. Open PN carries a higher risk of complication. SDOH are associated with significantly higher risk of postoperative complications following PN, regardless of the approach.

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 Aurtorino,
Rush university medical center