Emerging trends in robotic pyeloplasty for the management of ureteropelvic junction obstruction in adults

摘要

Purpose: We evaluated trends and associated characteristics in the use of robotics for pyeloplasty as treatment for ureteropelvic junction obstruction. Materials and Methods: Data from the Nationwide Inpatient Sample were used to evaluate pyeloplasty trends from 2005 to 2010. Patients treated with pyeloplasty and procedure method (robotic, laparoscopic or open) were identified by ICD-9-CM codes. Coding for robotics was initiated in the fourth quarter of 2008. Multivariable analysis was performed to examine characteristics affecting the odds of undergoing robotic pyeloplasty vs other approaches to pyeloplasty. Results: We identified 3,947 pyeloplasties performed between 2005 and 2010, including 1,642 since the fourth quarter of 2008. There was a statistically significant increase in the number of robotic pyeloplasties (p <0.001). Mean total charges for robotic vs nonrobotic procedures were $40,200 vs $37,817 (p = 0.106). Characteristics related to undergoing a robotic procedure included surgery at a teaching hospital (OR 1.29, 95% CI 1.04-1.59, p = 0.021) and in the Northeast (OR 1.54, 95% CI 1.17-2.04, p = 0.002) or Midwest (OR 1.62, 95% CI 1.23-2.12, p <0.001) compared with the South. When the primary payer was Medicaid vs private insurance, patients were 46% less likely to undergo the procedure robotically (p <0.001). There was no significant difference in charges between robotic and open pyeloplasty. Conclusions: The number of robotic pyeloplasties performed quarterly in the United States is increasing, although there are disparities in the adoption of the robotic approach among geographic regions and hospital types.