Hospital costs related to radical cystectomy are higher in the West than in all other regions of the United States, according to a study published in Surgical Oncology.

These higher costs were not explained by differences in patient characteristics or institutional characteristics, according to researchers.

The researchers analyzed patients in the National Inpatient Sample database who had non-metastatic bladder cancer and underwent radical cystectomy during 2016-2019. 

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The cohort included 5280 patients — 3200 who underwent open radical cystectomy, 1876 who underwent robot-assisted radical cystectomy, and 204 who underwent laparoscopic surgery. 

Patients were divided by region into Midwest (n=1441; 27%), Northeast (n=1031; 20%), South (n=1854; 35%), and West (n=954; 18%). 

There were no significant differences between the regions with regard to length of hospital stay, overall complication rate, or in-hospital mortality rate.

However, patients in the West had higher total hospital costs. This was true in the overall cohort, among patients who had open radical cystectomy, and among those who had robot-assisted radical cystectomy. 

Median Total Hospital Costs by Surgery Type and Region







Costs in the Entire Cohort





$38,809 (P <.001)

Costs in the Open Surgery Group





$36,137 (P <.001)

Costs in the Robot-Assisted Surgery Group





$43,119 (P <.001)

In a multivariable analysis, open radical cystectomies performed in the West were independently associated with higher total hospital costs (exponent beta, 1.39; 95% CI, 1.32-1.47; P <.001), and open surgeries in the South were associated with lower total hospital costs (exponent beta, 0.94; 95% CI, 0.90-0.98; P =.006).  

Another multivariable analysis showed that robot-assisted radical cystectomies performed in the West were independently associated with higher total hospital costs (exponent beta, 1.46; 95% CI, 1.38-1.54; P <.001). 

“Highest THC [total hospital costs] in the West could not be explained by variability in patient and/or institutional characteristics,” the researchers wrote. “The THC discrepancy clearly requires closer examination to identify underlying processes that contribute to inflated costs in the West.”


Hoeh B, Flammia RS, Hohenhorst L, et al. Regional differences in total hospital costs for radical cystectomy in the United States. Surgical Oncol. Published online March 9, 2023. doi:10.1016/j.suronc.2023.101924