Open Access

ARTICLE

Cost-effectiveness analysis of arterial catheter insertion on robotic-assisted laparoscopic prostatectomy

Rogelio Valdez^1,2, Johnathan Drevik³, Megan Prunty^1,2, Ilaha Isali^1,2, Mohit Sindhani⁴, Lee Ponsky^1,2, Alberto Castro Bigalli⁵, David Chen⁵, Kirtishri Mishra^1,2, Alexander Kutikov⁵, Adam Calaway^1,2, Laura Bukavina^1,5

1 Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
2 Case Western Reserve School of Medicine, Cleveland, Ohio, USA
3 Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
4 India Institute of Technology, Delhi, India
5 Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. Rogelio Valdez, Department of Urology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland OH 44106 USA

Canadian Journal of Urology 2023, 30(2), 11495-11501.

Abstract

Introduction: To evaluate the utility, outcomes, and cost of arterial line placement in a single institution cohort of patients undergoing robotic-assisted laparoscopic prostatectomy (RALP).
Materials and methods: A retrospective chart review was performed at a large tertiary care center from July 2018 through January 2021. Hospital costs and cost-effective analysis was performed on patients with and without arterial line placement. Means with standard deviations were used to report continuous variables, while numbers and percentages were utilized to describe categorical variables. T-tests and Chi-square tests compared categorical and continuous variables across study cohorts, respectively. Multivariable analyses were used to examine the association between A-line placement and outcomes as mentioned above adjusting for the effect of other co-variables.
Results: Among the 296 included patients, 138 (46.6%) had arterial lines. No preoperative patient characteristic predicted arterial line placement. Rates of complications and re-admissions were not statistically significant between the two groups. Arterial line use was associated with higher volumes of intraoperative fluid administration, as well as a longer hospital length of stay. Total cost and operative time did not significantly differ between cohorts, but arterial line placement increased variability of these factors.
Conclusion: The use of arterial lines in patients undergoing RALP is not necessarily guideline-driven and does not decrease the rate of perioperative complications. However, it is associated with longer length of stay and increases variability in charge. These data show that the surgical team and anesthesia team should critically evaluate the need for arterial line placement in patients undergoing RALP.

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