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.