Robot-assisted vs. open radical cystectomy: octogenarians vs. non octogenarians

Introduction: We quantified the effect of robot-assisted radical cystectomy (RARC) vs. open radical cystectomy (ORC) on adverse in-hospital outcomes in octogenarians (≥80 years) relative to non-octogenarians. Material and methods: Propensity score matching (PSM), multivariable logistic and Poisson regression models focused on adverse in-hospital outcomes in octogenarian and non-octogenarian patients treated with RARC vs. ORC, identified in National Inpatient Sample (2008–2019). Results: Overall, 13,922 RC patients were included. In 2002 octogenarians, after one-to-two PSM, 430 of 430 (100 %) RARC patients vs. 860 of 1572 (54.7 %) ORC patients were included. Octogenarians treated with RARC exhibited lower rates of adverse in-hospital outcomes than those treated with ORC in two of 12 examined categories: blood transfusions rate (18.6 vs. 28.1 %, OR 0.57) and prolonged length of stay (LOS) (17.7 vs. 25.5 %, OR 0.62), all p < 0.01. In 11,920 non-octogenarians, after one-to-two PSM, 2639 of 2639 (100 %) RARC patients vs. 5278 of 9281 (56.9 %) ORC patients were included. Non-octogenarians treated with RARC exhibited lower rates of adverse in-hospital outcomes than those treated with ORC in six of 12 examined categories: blood transfusion (12.6 vs. 23.2 %, OR 0.47), prolonged LOS (18.8 vs. 26.1 %, OR 0.66), overall complications (57.8 vs. 62.9 %, OR 0.82), respiratory (9.1 vs. 11.5 %, OR 0.78), wound (2.2 vs. 4.3 %, OR 0.50) and infectious complications (4.2 vs. 5.6 %, OR 0.74), all p < 0.05. Discussion: RARC offers more favorable in-hospital outcomes profile relative to ORC in both octogenarians and non-octogenarians. However, the magnitude of RARC benefit over ORC is less pronounced in octogenarians than in non-octogenarians.