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

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Abstract

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 $9618 versus $10,944 (14%), ventral hernia repair $10,739 versus $13,441 (25%), right colectomy $12,516 versus $15,027 (20%), left colectomy $14,157 versus $17,493 (24%), sigmoidectomy $13,504 versus $16,652 (23%), abdominoperineal resection $17,708 versus $19,605 (11%), and TAH $9368 versus $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.

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References

  1. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, Rockall T, Darzi A (2004) Dexterity enhancement with robotic surgery. Surg Endosc 18:790–795

    CAS  PubMed  Google Scholar 

  3. Morris B (2005) Robotic surgery: applications, limitations, and impact on surgical education. MedGenMed 7:72

    PubMed  PubMed Central  Google Scholar 

  4. Armijo PR, Pagkratis S, Boilesen E, Tanner T, Oleynikov D (2017) Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs. Surg Endosc 32:2106–2113

    Article  PubMed  Google Scholar 

  5. Halabi WJ, Kang CY, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, Pigazzi A (2013) Robotic-assisted colorectal surgery in the United States: a nationwide analysis of trends and outcomes. World J Surg 37:2782–2790

    Article  PubMed  Google Scholar 

  6. Roh HF, Nam SH, Kim JM (2018) Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: a systematic review and meta-analysis. PLoS ONE 13:e0191628

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Healthcare Cost and Utilization Project (2018) Overview of the National (Nationwide) Inpatient Sample (NIS). https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 4 Apr 2018

  8. Mahida JB, Cooper JN, Herz D, Diefenbach KA, Deans KJ, Minneci PC, McLeod DJ (2015) Utilization and costs associated with robotic surgery in children. J Surg Res 199:169–176

    Article  PubMed  Google Scholar 

  9. Shah J, Vyas A, Vyas D (2014) The history of robotics in surgical specialties. Am J Robot Surg 1:12–20

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jeong IG, Khandwala YS, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI (2017) Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015. JAMA 318:1561–1568

    Article  PubMed  PubMed Central  Google Scholar 

  11. Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26:598–606

    Article  PubMed  Google Scholar 

  12. Solaini L, Bazzocchi F, Cavaliere D, Avanzolini A, Cucchetti A, Ercolani G (2017) Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 32:1104–1110

    Article  PubMed  Google Scholar 

  13. Strosberg DS, Nguyen MC, Muscarella P, Narula VK (2017) A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis. Surg Endosc 31:1436–1441

    Article  PubMed  Google Scholar 

  14. Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK (2016) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 30:1576–1584

    Article  PubMed  Google Scholar 

  15. Barnett JC, Judd JP, Wu JM, Scales CD Jr, Myers ER, Havrilesky LJ (2010) Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer. Obstet Gynecol 116:685–693

    Article  PubMed  Google Scholar 

  16. Sarlos D, Kots L, Stevanovic N, Schaer G (2010) Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case–control study. Eur J Obstet Gynecol Reprod Biol 150:92–96

    Article  PubMed  Google Scholar 

  17. Avondstondt AM, Wallenstein M, D’Adamo CR, Ehsanipoor RM (2017) Change in cost after 5 years of experience with robotic-assisted hysterectomy for the treatment of endometrial cancer. J Robot Surg 12:93–96

    Article  PubMed  Google Scholar 

  18. Steinberg PL, Merguerian PA, Bihrle W, Seigne JD (2008) The cost of learning robotic-assisted prostatectomy. Urology 72:1068–1072

    Article  PubMed  Google Scholar 

  19. Bentley-Kumar K, Jackson T, Holland D, LeBlanc B, Agrawal V, Truitt MS (2016) Trauma patients: I can’t get no (patient) satisfaction? Am J Surg 212:1256–1260

    Article  PubMed  Google Scholar 

  20. Khorgami Z, Aminian A, Shoar S, Andalib A, Saber AA, Schauer PR, Brethauer SA, Sclabas GM (2017) Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample. Surg Obes Relat Dis 13:1284–1289

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, OK, USA

    Zhamak Khorgami, Wei T. Li, Theresa N. Jackson, C. Anthony Howard & Guido M. Sclabas

  2. Department of Surgery, College of Medicine, University of Oklahoma, 4502 E 41st Street, Tulsa, OK, 74135, USA

    Zhamak Khorgami

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  1. Zhamak Khorgami
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  2. Wei T. Li
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Correspondence to Zhamak Khorgami.

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Zhamak Khorgami, Wei T. Li, Theresa N. Jackson, C. Anthony Howard, and Guido M. Sclabas have no conflicts of interest or financial ties to disclose.

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Khorgami, Z., Li, W.T., Jackson, T.N. et al. The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc 33, 2217–2221 (2019). https://doi.org/10.1007/s00464-018-6507-3

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  • DOI: https://doi.org/10.1007/s00464-018-6507-3

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