Nurse-led coordinated surgical care pathways for cost optimization of robotic-assisted partial nephrectomy: medico-economic analysis of the UroCCR-25 AMBU-REIN study

Bernhard, Jean-Christophe; Robert, G.; Ricard, S.; Rogier, Julien; Degryse, C.; Michiels, C.; Margue, G.; Blanc, Peggy; Estrade, V.; Capon, G.; Bladou, Franck; Ferrière, Jean-Marie

doi:10.1007/s00345-022-04066-4

Cited by 3 publications

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“…In France, some centres already only use the robotic approach for PN, convinced of the net benefits of this surgical approach, both for patients and hospitals. Outpatient RPN has even been implemented in Bordeaux for selected patients, supported by a dedicated, nurse-led clinical pathway, and has been shown to provide a high level of patient satisfaction as well as economic optimization of robotic assistance 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

“…These advantages could balance out the cost of robotic assistance. In their meta-analysis, Wu et al 6 found that the overall cost of RPN was not significantly higher than that of OPN, and Bernhard et al 25 recently reported that implementing RPN along with enhanced recovery after surgery and day-case nurse-led protocols may facilitate the economic sustainability of robotic assistance for hospitals where the extra cost is not covered by the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study)

Ingels

Bensalah²,

Beauval³

et al. 2022

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We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35–0.66]; severe: 0.29 [0.16–0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%