Purpose: To compare the perioperative outcomes and costs between open and laparoscopic nephroureterectomy for malignant diseases on a contemporary population-based level.
Patients and methods: Based on the Japanese Diagnosis Procedure Combination database for 2010 to 2012, we compared six end points of in-hospital mortality, intraoperative and postoperative complications, transfusion, anesthesia time, postoperative length of stay, and costs between open and laparoscopic nephroureterectomy under one-to-one matching based on the propensity scores. Multivariate analyses included sex, age, Charlson comorbidity index, body mass index, oncologic stage, hospital volume, and hospital academic status. Missing values were filled in by five-copy multiple imputations.
Results: Among 3595 open and 3349 laparoscopic nephroureterectomies, an average of 2902 matched pairs were generated by the imputation and matching process. The outcomes showing significantly favorable association with the laparoscopic approach over the open approach were in-hospital mortality (0.3% vs 0.7%; odds ratio [OR], 0.41 [95% confidence interval, CI, 0.17 to 0.99]), postoperative complications (9.4% vs 12.6%; OR, 0.73 [0.58 to 0.91]), transfusion (12.9% vs 20.6%; OR, 0.54 [0.46 to 0.64]), postoperative length of stay (median, 11 vs 12 days; Beta, -0.041 [-0.059 to -0.023]), and costs without the operating room (median, $6607 vs $7077; Beta, -0.030 [-0.048 to -0.013]), while significantly longer anesthesia time (median, 278 vs 245 min; Beta, 0.057 [0.041 to 0.074]) and higher total costs (median, $15691 vs $12846; Beta, 0.078 [0.068 to 0.088]) for laparoscopic than for open nephroureterectomies were noted. There was no difference in intraoperative complications (P=0.774).
Conclusion: Several favorable perioperative outcomes including low mortality were observed in laparoscopic nephroureterectomy compared with open nephroureterectomy.