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Robotic Versus Laparoscopic Cholecystectomy Inpatient Analysis: Does the End Justify the Means?

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background and Objectives

Robotic-assisted cholecystectomy (RAC) was introduced several years ago. With its more extensive use by surgeons, more information is needed regarding clinical and economic outcomes.

Methods

The Nationwide Inpatient Sample from the Health Cost Utilization Project was analyzed using HCUPnet, National Inpatient Sample (NIS) datasets and SAS 9.2 for the years 2010–2011. Queries were made for RAC and laparoscopic cholecystectomy (LC) procedures with a primary diagnosis of gallbladder disease. Overall charges, costs, number of chronic conditions, comorbidities, and length of stay were calculated.

Results

RAC was $7518, +54 % (p < 0.05), and $4044, +29 % (p < 0.05), more costly compared to LC in 2010 and 2011, respectively. Total costs for RAC decreased by 14.6 % (p = 0.27) between 2010 and 2011, even though RAC was still costlier than LC in 2011. There was no significant difference in the LOS between RAC and LC in either years. Patients undergoing RAC had an increased number of chronic conditions compared to patients undergoing LC in both 2010 and 2011.

Conclusion

LOS of RAC is similar to LC. Cost of RAC remains higher compared to LC although there was reduction in cost of RAC in 2011 versus 2010.

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References

  1. Everhart JE, Khare M, Hill M, et al. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117(3):632–9.

    Article  CAS  PubMed  Google Scholar 

  2. Tsui C, Klein R, Garabrant M. Minimally invasive surgery: national trends in adoption and future directions for hospital strategy. Surg Endosc 2013; 27(7):2253–7.

    Article  PubMed  Google Scholar 

  3. Litwin DE, Cahan MA. Laparoscopic cholecystectomy. Surg Clin North Am 2008; 88(6):1295–313, ix.

    Article  PubMed  Google Scholar 

  4. Himpens J, Leman G, Cadiere GB. Telesurgical laparoscopic cholecystectomy. Surg Endosc 1998; 12(8):1091.

    Article  CAS  PubMed  Google Scholar 

  5. Kroh M, El-Hayek K, Rosenblatt S, et al. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc 2011; 25(11):3566–73.

    Article  PubMed  Google Scholar 

  6. Talamini MA, Chapman S, Horgan S, et al. A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 2003; 17(10):1521–4.

    Article  CAS  PubMed  Google Scholar 

  7. Breitenstein S, Nocito A, Puhan M, et al. Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study. Ann Surg 2008; 247(6):987–93.

    Article  PubMed  Google Scholar 

  8. Buzad FA, Corne LM, Brown TC, et al. Single-site robotic cholecystectomy: efficiency and cost analysis. Int J Med Robot 2013; 9(3):365–70.

    Article  PubMed  Google Scholar 

  9. Agency for Healthcare Research and Policy. HCUPnet. Accessed December 27, 2013. Available at: http://hcupnet.ahrq.gov. Accessed December 27, 2013.

  10. Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care 1998; 36(1):8–27.

    Article  CAS  PubMed  Google Scholar 

  11. Guller U, Jain N, Hervey S, et al. Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 2003; 138(11):1179–86.

    Article  PubMed  Google Scholar 

  12. Zilberberg MD, Shorr AF, Huang H, et al. Hospital days, hospitalization costs, and inpatient mortality among patients with mucormycosis: a retrospective analysis of US hospital discharge data. BMC Infect Dis 2014; 14(1):310.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Shwartz M, Young DW, Siegrist R. The ratio of costs to charges: how good a basis for estimating costs? Inquiry 1995; 32(4):476–81.

    PubMed  Google Scholar 

  14. Enomoto LM, Gusani NJ, Dillon PW, et al. Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy. J Gastrointest Surg 2014; 18(4):690–700.

    Article  PubMed  Google Scholar 

  15. Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg 1992; 127(8):917–21; discussion 921–3.

  16. Schirmer BD, Edge SB, Dix J, et al. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg 1991; 213(6):665–76; discussion 677.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Wiesen SM, Unger SW, Barkin JS, et al. Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol 1993; 88(3):334–7.

    CAS  PubMed  Google Scholar 

  18. Wilson RG, Macintyre IM, Nixon SJ, et al. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ 1992; 305(6850):394–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1993; 217(3):233–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Johansson M, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 2005; 92(1):44–9.

    Article  CAS  PubMed  Google Scholar 

  21. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14(1):91–7.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Gutt CN, Encke J, Koninger J, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 2013; 258(3):385–93.

    Article  PubMed  Google Scholar 

  23. Zaydfudim V AK, Sarr MG. Gallbladder and Biliary Tree. In Cameron JL, ed. Current Surgical Therapy. Philadelphia, PA: Elsevier Saunders, 2014.

  24. Wren SM, Curet MJ. Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg 2011; 146(10):1122–7.

    Article  PubMed  Google Scholar 

  25. Lendvay TS, Hannaford B, Satava RM. Future of robotic surgery. Cancer J 2013; 19(2):109–19.

    Article  PubMed  Google Scholar 

  26. Anderson JE, Chang DC, Parsons JK, et al. The first national examination of outcomes and trends in robotic surgery in the United States. J Am Coll Surg 2012; 215(1):107–14; discussion 114–6.

    Article  PubMed  Google Scholar 

  27. Salman M, Bell T, Martin J, et al. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg 2013; 79(6):553–60.

    PubMed  Google Scholar 

  28. Daskalaki D, Fernandes E, Wang X, et al. Indocyanine Green (ICG) Fluorescent Cholangiography During Robotic Cholecystectomy: Results of 184 Consecutive Cases in a Single Institution. Surg Innov 2014.

  29. Fuller JK. Surgical Technology: Principles and Practice. Sixth ed. St Louis, Missouri: Elsevier, 2013.

  30. Rao A, Polanco A, Qiu S, et al. Safety of outpatient laparoscopic cholecystectomy in the elderly: analysis of 15,248 patients using the NSQIP database. J Am Coll Surg 2013; 217(6):1038–43.

    Article  PubMed  Google Scholar 

  31. Kanaan SA, Murayama KM, Merriam LT, et al. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res 2002; 106(1):20–4.

    Article  PubMed  Google Scholar 

  32. Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS 2010; 14(4):476–483.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004; 188(3):205–11.

    Article  PubMed  Google Scholar 

  34. Jain PK, Hayden JD, Sedman PC, et al. A prospective study of ambulatory laparoscopic cholecystectomy: training economic, and patient benefits. Surg Endosc 2005; 19(8):1082–5.

    Article  CAS  PubMed  Google Scholar 

  35. Fleisher LA, Yee K, Lillemoe KD, et al. Is outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care. Anesthesiology 1999; 90(6):1746–55.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Drs. Kamiński, Bueltmann, and Rudnicki have no conflicts of interest or financial ties to disclose.

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Correspondence to Jan P. Kamiński.

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Kamiński, J.P., Bueltmann, K.W. & Rudnicki, M. Robotic Versus Laparoscopic Cholecystectomy Inpatient Analysis: Does the End Justify the Means?. J Gastrointest Surg 18, 2116–2122 (2014). https://doi.org/10.1007/s11605-014-2673-3

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  • DOI: https://doi.org/10.1007/s11605-014-2673-3

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