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Bernhard JC, Robert G, Ricard S, Rogier J, Degryse C, Michiels C, Margue G, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Ferriere JM. 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 2023; 41:325-333. [PMID: 35727334 DOI: 10.1007/s00345-022-04066-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
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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Affiliation(s)
- Jean-Christophe Bernhard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France.
| | - Grégoire Robert
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Solène Ricard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France
| | - Julien Rogier
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Cécile Degryse
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Peggy Blanc
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
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Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study). Sci Rep 2022; 12:18981. [PMID: 36347900 PMCID: PMC9643517 DOI: 10.1038/s41598-022-22912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
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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Hutin M, Trétarre B, Gras C, Bessaoud F, Daurès JP, Delbos O, Bringer JP, Ayuso D, Thuret R, Azria D, Serre I, Brel D, Reis Borges R, Iborra F, Rébillard X. [Renal cell carcinoma in the department of Hérault: Results over a 30 year period]. Prog Urol 2020; 31:175-182. [PMID: 33160850 DOI: 10.1016/j.purol.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of the study was to determine the specificities of renal cell carcinoma (RCC) in the department of Herault using the Herault Tumor Registry over 30 years. METHODS Data of this study were obtained from the Herault cancer database. We analysed the evolution of RCC from 1987 to 2016, including the incidence, mortality, cancer pathology and staging at the moment of diagnosis. We compared our results with national and international data. RESULTS We identified 3769 newly diagnosed RCC: 2628 in men (69,7%) and 1141 in women (30,3%). In 2016, RCC was the 8th most frequent cancer, both genders combined, the 7th most frequent cancer in men and the 11th in women. New cases of RCC increased by 4.2 in men and 3.3 in women over the study period. The number of localised forms increased by 9% over 20 years. In 2016, the probability of having a RCC before the age of 75 was of 2.11% for a man and of 0.62% for a woman. CONCLUSION Over 30 years, the incidence rate of RCC increased in the department of Herault; however, mortality decreased over the same period. This analytical data should be improved by the development of the Registry of Herault Specialised in Onco-Urology (RHESOU). LEVEL OF EVIDENCE 3.
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Affiliation(s)
- M Hutin
- Service d'urologie, Clinique Beau Soleil, 119, avenue de Lodève, 34070 Montpellier, France; Service d'urologie, Centre Hospitalier Intercommunal du Bassin de Thau, boulevard Camille Blanc, 34200 Sète, France.
| | - B Trétarre
- Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France
| | - C Gras
- Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France
| | - F Bessaoud
- Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France
| | - J-P Daurès
- Service d'urologie, Clinique Beau Soleil, 119, avenue de Lodève, 34070 Montpellier, France; Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France
| | - O Delbos
- Urodoc, 265, avenue des Etats du Languedoc, 34000 Montpellier, France
| | - J-P Bringer
- Polyclinique Saint Privat, rue de la Margeride, 34760 Boujan-sur-Libron, France; Centre Hospitalier de Béziers, 2, rue Valentin Hauy, 34500 Béziers, France
| | - D Ayuso
- Service d'urologie, Centre Hospitalier Intercommunal du Bassin de Thau, boulevard Camille Blanc, 34200 Sète, France
| | - R Thuret
- Centre Hospitalier Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - D Azria
- Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France; Institut du Cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - I Serre
- Centre Hospitalier Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - D Brel
- Centre de pathologie Biterrois, 101, avenue Jean-Moulin, 34500 Béziers, France
| | - R Reis Borges
- Inopath Labosud Alco, 141, avenue Paul-Bringuier, 34080 Montpellier, France
| | - F Iborra
- Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France; Centre Hospitalier Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - X Rébillard
- Service d'urologie, Clinique Beau Soleil, 119, avenue de Lodève, 34070 Montpellier, France; Registre des Tumeurs de l'Hérault, 208, rue des Apothicaires, 34298 Montpellier Cedex 5, France
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