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Outcomes and costs with the introduction of robotic-assisted thoracic surgery in public hospitals

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Abstract

Robotic-assisted thoracic surgery (RATS) is an effective treatment of non-small cell lung cancer (NSCLC) but the effects of its implementation in university hospital networks has not been described. We analyzed the early clinical outcomes, estimated costs, and revenues associated with three robotic systems implemented in the Paris Public Hospital network. A retrospective study included patients who underwent RATS for NSCLC in 2019 and 2020. Ninety-day morbidity, mortality, hospital costs, and hospital revenues were described. Economic analyses were conducted either from the hospital center or from the French health insurance system perspectives. Cost drivers were tested using univariate and multivariable analyses. Sensitivity analyses were performed to assess uncertainty over in-hospital length of stay (LOS), number of robotic surgeries per year, investment cost, operating room occupancy time, maintenance cost, and commercial discount. The study included 188 patients (65.8 ± 9.3 years; Charlson 4.1 ± 1.4; stage I 76.6%). Median in-hospital LOS was 6 days [5–9.5], 90-day mortality was 1.6%. Mean hospital expenses and revenues were €12,732 ± 4914 and €11,983 ± 5708 per patient, respectively. In multivariable analysis, factors associated with hospital costs were body mass index, DLCO, major complications, and transfer to intensive care unit. Sensitivity analyses showed that in-hospital LOS (€11,802-€15,010) and commercial discounts on the list price (€11,458-€12,732) had an important impact on costs. During the first 2 years following the installation of three robotic systems in Paris Public Hospitals, the clinical outcomes of RATS for NSCLC have been satisfactory. Without commercial discount, hospital expenses would have exceeded hospital revenues.

Clinical registration number CNIL, N°2221601, CERC-SFCTCV-2021-07-20–Num17_MOPI_robolution.

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Availability of data

The data that support the findings of this study are available on request from the corresponding author, [H.I.].

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Funding

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Authors and Affiliations

  1. Department of Vascular Surgery, Thoracic Surgery, and Lung Transplantation, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France

    Léa Betser, Arnaud Roussel, Yves Castier & Pierre Mordant

  2. Clinical Research Unit Eco Ile de France, Hôtel-Dieu, Paris, France

    Alicia Le Bras & Isabelle Durand-Zaleski

  3. Department of Thoracic and Vascular Surgery, Hôpital Tenon, Paris, France

    Harry Etienne & Jalal Assouad

  4. Department of Thoracic Surgery, Hôpital Cochin, Paris, France

    Antonio Bobbio & Marco Alifano

  5. Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France

    Charles Al-Zreibi

  6. Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Bobigny, France

    Emmanuel Martinod

  7. Department of Public Health, Université Paris Est, Hôpital Henri Mondor, Créteil, France

    Isabelle Durand-Zaleski

  8. Hôpitaux de Paris, Paris, France

    Léa Betser, Alicia Le Bras, Harry Etienne, Arnaud Roussel, Antonio Bobbio, Charles Al-Zreibi, Emmanuel Martinod, Marco Alifano, Yves Castier, Jalal Assouad, Isabelle Durand-Zaleski & Pierre Mordant

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  1. Léa Betser
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  2. Alicia Le Bras
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  10. Jalal Assouad
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  11. Isabelle Durand-Zaleski
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  12. Pierre Mordant
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lea BETSER, Pierre MORDANT, Alicia LE BRAS, Isabelle DURAND-ZALESKI, and Harry ETIENNE. The first draft of the manuscript was written by Lea BETSER and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Pierre Mordant.

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Betser, L., Le Bras, A., Etienne, H. et al. Outcomes and costs with the introduction of robotic-assisted thoracic surgery in public hospitals. J Robotic Surg 18, 124 (2024). https://doi.org/10.1007/s11701-024-01879-w

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  • DOI: https://doi.org/10.1007/s11701-024-01879-w

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