Robot‐Assisted Versus Open Radical Cystectomy: Comparison of Adverse In‐Hospital Outcomes

Purpose: To quantify improvements in adverse in-hospital outcomes between historical and contemporary robot-assisted radical cystectomy (RARC) versus historical and contemporary open RC (ORC). Material and Methods: Within the National Inpatient Sample (2010–2019), RARC and ORC ileal conduit diversion patients were identified. Multivariable logistic and Poisson regression models were fitted. Results: Of RARC patients, 1343 (39%) were historical (2010–2014) and 2087 (61%) were contemporary (2015–2019). Of ORC patients, 5812 (54%) were historical and 5019 (46%) were contemporary. Versus historical counterparts, contemporary RARC patients exhibited significantly better adverse in-hospital outcomes in 9 of 13 categories, with improvements ranging from −82% for intraoperative complications to −22% for cumulative postoperative complications. Similarly, versus historical, contemporary ORC patients also exhibited significantly better adverse in-hospital outcomes in 9 of 13 categories, with improvements ranging from −72% for intraoperative complications to −12% for median length of stay (LOS). When contemporary RARC was compared to contemporary ORC, RARC adverse in-hospital outcomes were better in 7 of 13 comparisons, with improvements ranging from −55% for blood transfusions to −18% for median LOS. Similarly, when historical RARC was compared to historical ORC, RARC adverse in-hospital outcomes were better in 6 of 13 comparisons, with improvements ranging from −55% for blood transfusions to −15% for median LOS. Conclusion: The magnitude of the improvement in adverse in-hospital outcomes was comparable between contemporary versus historical RARC (nine improved categories) and contemporary versus historical ORC (nine improved categories). However, contemporary RARC outperformed contemporary ORC in 7 of 13 categories of adverse in-hospital outcomes.