PD30-11 ECONOMIC AND UTILIZATION ANALYSIS OF ROBOTIC-ASSISTED VS. LAPAROSCOPIC LIVE DONOR NEPHRECTOMY

INTRODUCTION AND OBJECTIVES: In the past five years, there has been increased performance of robotic-assisted live-donor nephrectomy. Although it remains uncommon, it is important to understand the current utilization of robotic-assistance to determine if there is benefit over laparoscopic live-donor nephrectomy. METHODS: All adult cases of live-donor nephrectomy were identified from the 2009-2011 Nationwide Inpatient Sample (NIS) using ICD-9 medical and procedure codes (V59.4 and 55.51). Laparoscopic (54.21 and 54.51) and robotic cases (174.x) were identified for inclusion. Peri-operative complications were determined using ICD-9 CM codes (996-999) Population weighting using NIS discharge weights was used to estimate national rates. Descriptive analysis of categorical and continuous variables was performed using the Pearson chi-squared and the Mann Whitney tests, respectively. Cost data was missing on the majority of robotic-assisted patients, and thus only total charge was used in the final analysis. RESULTS: After population weighting 4,163 cases were identified for inclusion, 142 (3.4%) of which were performed with roboticassistance. There were no differences in age or sex between the populations. All robotic-assisted cases occurred in the Northwest region. The median (interquartile range (IQR)) length of stay for roboticassisted live-donor nephrectomy was 3 (3-4) days compared with 2 (2-3) days for laparoscopic (p<0.001). Median (IQR) total charges for robotic-assisted live-donor nephrectomy were $48,639 (42,380-53,050) vs. $37,019 (28,715-48,816) for laparoscopic (p<0.001). There was no statistical difference in the number of complications, although there were none in the robotic-assisted live-donor nephrectomy group (p1⁄40.206). CONCLUSIONS: Live-donor nephrectomy is infrequently performed with robotic-assistance. As the number of patients for study was small, it is difficult to make definitive conclusions; however, our findings indicate that robotic-assisted live-donor nephrectomy is associated with higher charges and longer hospitalization. Subsequent studies that examine post-operative complications will help define if there is a role for robotic-assistance in live-donor nephrectomy.