The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample

Z Khorgami, WT Li, TN Jackson, CA Howard… - Surgical …, 2019 - Springer
Z Khorgami, WT Li, TN Jackson, CA Howard, GM Sclabas
Surgical endoscopy, 2019Springer
Background Robotic-assisted surgery (RAS) with its advantages continues to gain popularity
among surgeons. This study analyzed the increased costs of RAS in common surgical
procedures using the National Inpatient Sample. Methods Retrospective analysis of the
2012–2014 Healthcare Cost and Utilization Project-NIS was performed for the following
laparoscopic/robotic procedures: cholecystectomy, ventral hernia repair, right and left
hemicolectomy, sigmoidectomy, abdominoperineal resection, and total abdominal …
Background Robotic-assisted surgery (RAS) with its advantages continues to gain popularity among surgeons. This study analyzed the increased costs of RAS in common surgical procedures using the National Inpatient Sample. Methods Retrospective analysis of the 2012–2014 Healthcare Cost and Utilization Project-NIS was performed for the following laparoscopic/robotic procedures: cholecystectomy, ventral hernia repair, right and left hemicolectomy, sigmoidectomy, abdominoperineal resection, and total abdominal hysterectomy (TAH). Patients with additional concurrent procedures were excluded. Costs were compared between the laparoscopic procedures and their RAS counterparts. Total costs and charges for cholecystectomy (the most common procedure in the dataset) were compared based on the payer and characteristics of hospital (region, rural/urban, bed size, and ownership). Results A total of 91,630 surgeries (87,965 laparoscopic, 3665 robotic) were analyzed. The average cost for the laparoscopic group was 10,227± 4986 versus 12,340± 5880 for the robotic cases (p< 0.001). The overall and percentage increases for laparoscopic versus robotic for each procedure were as follows: cholecystectomy 9618versus 10,944 (14%), ventral hernia repair 10,739versus 13,441 (25%), right colectomy 12,516versus 15,027 (20%), left colectomy 14,157versus 17,493 (24%), sigmoidectomy 13,504versus 16,652 (23%), abdominoperineal resection 17,708versus 19,605 (11%), and TAH 9368versus 9923 (6%). Hysterectomy was the only procedure performed primarily using RAS and it was found to have the lowest increase in costs. Increased costs were associated with even higher increases in charges, especially in investor-owned private hospitals. Conclusion RAS is more costly when compared to conventional laparoscopic surgery. Additional costs may be lower in centers that perform a higher volume of RAS. Further analysis of long-term outcomes (including reoperations and readmissions) is needed to better compare the life-long treatment costs for both surgical approaches.
Springer
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