To compare 30-day healthcare utilization (HCU) following open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC). HCU was assessed using a composite endpoint including prolonged hospital stay, major postoperative complications, and discharge to a skilled nursing or rehabilitation facility.

We conducted a retrospective cohort analysis using the ACS-NSQIP database (2019-2022). Adults with bladder cancer who underwent RC were included; interfacility admissions were excluded. The primary outcome was high HCU, defined as ≥1 of: prolonged stay (≥8 days), major complication, or discharge to skilled nursing/rehabilitation. Multivariable logistic regression estimated the association between approach and HCU, adjusted for ASA class, stage, diversion, and frailty.

A total of 3712 patients were included as follows: 2593 (69.8%) ORC and 1119 (30.2%) RARC. Baseline demographics were similar, though ORC had more T4 disease (14% vs 5%, P = .017). In unadjusted analyses, RARC had lower HCU rates (31.5% vs 57%, P = .01). By domain, RARC had fewer major complications (25.6% vs 48.2%), prolonged stays (9.7% vs 19.1%), and discharges to continued care (6.3% vs 10.2%) (all P = .01). On adjusted analysis, RARC was associated with reduced odds of high HCU (aOR 0.51, 95% CI 0.41-0.63), prolonged stay (aOR 0.44, 0.35-0.56), discharge to continued care (aOR 0.61, 0.44-0.85), and major complications (aOR 0.38, 0.32-0.44).

Compared to ORC, RARC was independently associated with lower postoperative healthcare utilization, driven by fewer complications, shorter stays, and reduced need for continued care.