Introduction: With the rise of robotic surgery, there has been much debate on the cost/benefit of robotic vs open surgery. Most studies examining the outcomes and costs of robotic surgery have been done in the context of robotic-assisted laparoscopic radical prostatectomy with limited studies of the cost/benefit for other indications such as simple prostatectomy or cystectomy. We sought to examine the monetary costs, hospital resource utilization, and short-term complications of robotic vs open simple prostatectomy in a national cohort. Methods: We performed a retrospective cohort study of adult men undergoing elective open and robotic simple prostatectomy from 2011 to 2020 using data from the Premier Hospital Database (PHD), a national hospital discharge dataset representing approximately 20% of non-federal hospital discharges in the United States. We assessed for associations between surgical approach and postoperative outcomes including surgical complications, operating room time, need for blood transfusion, length of stay, readmissions and overall costs. All multivariable logistic and quantile regression models were controlled for clinical, demographic, and hospital factors. Analyses used sampling weights to achieve a nationally representative estimation. Results: A total of 7,119 men in PHD, representing a weighted sample of 27,232 patients, underwent simple prostatectomy during 2011-2020. In the study period, the portion of robotic procedures increased from 5.1% to 26.4% of annual cases. There were no differences in the 90-day minor (Clavien grade 1-2) and major (Clavien grade 3-5) complications, although the open approach was more commonly associated with intraoperative and postoperative hemorrhage (OR: 1.90, 95% CI: 1.25 to 2.90, p=0.003). The robotic approach was associated with longer median operating room time (+135 min, 95% CI: 120 to 151 min, p<0.0001), shorter hospitalization (-1.5 day, 95% CI: -1.71 to -1.29 days, p<0.0001), and no difference in the odds for 90-day readmission. The 90-day cost was significantly higher for robotic simple prostatectomy (+US$3,550, 95% CI: $3,044 to $4,057, p<0.0001). Conclusions: There is a gradual increase in the proportion of simple prostatectomies in the United States performed via the robotic approach. The 90-day cost of robotic simple prostatectomy was significantly higher despite the shorter hospital length of stay—likely due to higher equipment costs and longer operative times—with no differences in major or minor complications. SOURCE OF Funding: None
