Simon P. Kim

INTRODUCTION: We sought to assess the comparative hospital outcomes and costs amongst a population-based cohort of bladder cancer (BCa) patients by surgical approach and diversion. MATERIAL AND METHODS: From a privately insured national database, we identified all BCa patients who underwent open or robotic RC and ileal conduit (IC) or neobladder (NB) from 2010 to 2015. The primary outcomes were length of stay (LOS), readmissions and total health care costs at 90-days from surgery. We used multivariable logistic regression and generalized estimating equations to assess for 90-day readmission and health care costs, respectively. RESULTS: Most patients underwent open RC with IC (56.7%; n = 1680) followed by open RC with NB (22.7%; n = 672), robotic RC with IC (17.4%; n = 516), and robotic RC with NB (3.1%; n = 93). On multivariable analysis, patients had higher odds of 90-day readmissions for open RC and NB (OR: 1.36; p = 0.002) and robotic RC with NB (OR 1.60; p = 0.03) relative to open RC with IC. After adjusting for patient covariates, we also found lower adjusted total 90-day health care costs for open RC with IC ($67,915) and open RC with NB ($67,371) compared to robotic RC with IC ($70,677) and NB ($70,818; p < 0.05). CONCLUSIONS: In our study, NB diversion was associated with higher odds of 90-day readmission, while robotic surgery increased total 90-day health care costs.

The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a nationa