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

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Abstract

Purpose

Robot-assisted partial nephrectomy (RAPN) reduces morbidity, enabling development of Enhanced Recovery After Surgery (ERAS) and day-case protocols. Additional financial costs limit its integration into clinical practice. We evaluated the medico-economic impact of RAPN using a nurse-led coordinated pathway of care (NLC-RAPN).

Methods

All tumor RAPNs performed in 2017 were prospectively included in nurse-led protocols: NP-RAAC (ERAS) or Ambu-Rein (day case). Clinico-biological and pathological data were prospectively collected within the French Research Network for Kidney Cancer database (NCT03293563). Estimated costs were compared to “average” patients at the national level operated by open partial nephrectomy (OPN) or RAPN, using data from the 2017 French hospital discharge database and the national cost scale.

Results

The NLC-RAPN cohort (n = 151) included 27 (18%) outpatients and the average hospital length of stay (LOS) was 2.4 days. In the national control cohorts for OPN (n = 2475) and RAPN (n = 3529), the average LOS were 8.0 and 5.2 days, respectively. The mean incomes per group were €7607 for NLC-RAPN, €9813 for OPN, and €8215 for RAPN. The mean daily cost of stay was €659 for NLC-RAPN, €838 for OPN, and €725 for RAPN. The overall cost for NLC-RAPN was €6594, €8733 for OPN, and €8763 for RAPN. The best operational margin was obtained for day-case NLC-RAPN (€1967).

Conclusion

Combining RAPN with nurse-led coordinated pathways of care led to a shorter hospital stay and reduced costs versus OPN. This may facilitate the economic sustainability of robotic assistance for hospitals where the extra cost is not covered by the healthcare system.

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Acknowledgements

The draft manuscript was edited by Deborah Nock (Medical WriteAway, Norwich, UK), with full review and approval by all authors.

Funding

French National Cancer Institute (INCa), French Ministry of Health (DGOS).

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Authors and Affiliations

  1. Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France

    Jean-Christophe Bernhard, Grégoire Robert, Solène Ricard, Clément Michiels, Gaëlle Margue, Peggy Blanc, Eric Alezra, Vincent Estrade, Grégoire Capon, Franck Bladou & Jean-Marie Ferriere

  2. UroCCR, French Research Network On Kidney Cancer, Bordeaux, France

    Jean-Christophe Bernhard & Solène Ricard

  3. Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France

    Julien Rogier & Cécile Degryse

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  1. Jean-Christophe Bernhard
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  2. Grégoire Robert
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Contributions

Protocol/project development: JCB, SR. Data collection or management: SR, JCB, CM, GM, GR, EA, PB, VE, GC, JR. Data analysis: JCB, SR, CD, FB, JMF Manuscript writing/editing: JCB.

Corresponding author

Correspondence to Jean-Christophe Bernhard.

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Conflict of interest

JCB declare to be proctor for Intuitive Surgical.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee CPP Sud-Ouest et Outre-mer (approval DC 2012-108) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplementary Information

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Supplementary file1 Details of the cost analysis (DOCX 27 kb)

345_2022_4066_MOESM2_ESM.docx

Supplementary file2 a GHS (groupe homogène de séjours) incomes. b Supplements for stays in intensive care units (DOCX 20 kb)

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Bernhard, JC., Robert, G., Ricard, S. et al. Nurse-led coordinated surgical care pathways for cost optimization of robotic-assisted partial nephrectomy: medico-economic analysis of the UroCCR-25 AMBU-REIN study. World J Urol 41, 325–333 (2023). https://doi.org/10.1007/s00345-022-04066-4

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