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

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

doi:10.1007/s00464-018-6507-3

Cited by 89 publications

(48 citation statements)

References 18 publications

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“…In addition, we found no clinical, patient centered, or economic benefit to RVHR compared with LVHR. The results of this study are in line with most other comparative studies published from large datasets comparing RVHR and LVHR: no clinical benefit, with increased operative duration and healthcare costs 33343536…”

Section: Discussionsupporting

confidence: 90%

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Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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ObjectiveTo determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair.DesignPragmatic, blinded randomized controlled trial.SettingMultidisciplinary hernia clinics in Houston, USA.Participants124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019.InterventionsRobotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59).Main outcome measuresThe primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat.ResultsPatients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair.ConclusionThis study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs.Trial registrationClinicaltrials.gov NCT03490266.

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Section: Discussionsupporting

confidence: 90%

“…The results of this study are in line with most other comparative studies published from large datasets comparing RVHR and LVHR: no clinical benefit, with increased operative duration and healthcare costs. 33 34 35 36 …”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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“…While individual institutions have found comparable costs between laparoscopic and robotic platforms, 14,15 our cost analysis of charges appear to mirror the national United State databases which demonstrate that hospital charges are significantly increased with use of the robot. 16,17 The $15,000 increase seen at our hospital however does not reflect any actual payments received from insurers based on these charges. Nor are we privy to any upcharges made to insurance companies at our institution to cover other costs-associated robotic surgery such as operating room time (estimated at w2200$/h 18 ), staffing for certified first assistants, and for the upfront purchase of the robotic system.…”

Section: Discussionmentioning

confidence: 78%

Sigmoidectomy for Diverticulitis—A Propensity-Matched Comparison of Minimally Invasive Approaches

Ogilvie

Saunders

Parker

et al. 2019

Journal of Surgical Research

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a b s t r a c tBackground: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication. Methods:We identified all elective cases of laparoscopic-and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol. We performed propensity matching based on surgical indications (recurrent disease, ongoing symptoms, or fistula), stoma creation, and body mass index to create a matched cohort. Our primary outcomes were return of bowel function, length of stay, opioid use, and pain scores during the first 72 h postoperatively. Secondary outcomes were operative room and hospital charges.Results: From 2011 to 2016, 69 robotic cases were propensity matched from a group of 222 laparoscopic cases to create a 1:1 case ratio that was equivalent in terms of patient demographics and operative indications. Time to first bowel movement was slightly quicker in the robotic group (1 [1] versus 2 [1.5], P ¼ 0.09), while length of stay (3.5 [1.6] versus 3.6 [1.4] d, P ¼ 0.64) was equivalent. Pain scores were lower in the robotic group on day 0 (4.6 versus 6.1, P ¼ 0.0001), but similar on day 1 and day 2 (4.3 versus 4.1, P ¼ 0.62 and 3.8 versus 3.3, P ¼ 0.19). There was no difference in postoperative 72-h opioid use between groups (110.8 MME [144.5] versus 97.4 MME [101.5], P ¼ 0.70). In the robotic arm operating room charges were slightly more ($2835 AE $394 versus $2196 AE $359, P < 0.0001), but total hospital charges were over significantly increased ($41,159 [$7840] versus $25,761 [$11,689], P < 0.0001).Conclusions: Via a carefully matched cohort of elective sigmoid resection for diverticular disease at a single community institution, we have demonstrated that laparoscopic-and robotic-assisted surgery result in clinically equivalent return of bowel function, length of stay, postoperative pain, and opioid use. ª

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“…One of the most critical issues for robotic surgery remains the cost, with institutions and payers being concerned about acquisition, maintenance, equipment and implementation. Actually, most of the available studies in different surgical specialties and subspecialties show higher costs related to robotic surgery when compared to its laparoscopic counterpart [32,64,65]. Unfortunately, to date, most of the studies have focused only on the direct costs related to the purchase and maintenance of the robot, along with the related instrumentation per procedure.…”

Section: Costsmentioning

confidence: 99%

Update on Robotic Total Mesorectal Excision for Rectal Cancer

Giuratrabocchetta

Formisano

Salaj

et al. 2021

JPM

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The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one of the main drawbacks of robotic surgery, should be thoroughly evaluated including both the direct and indirect costs, with the latter having the potential of counterbalancing the excess of expenditure directly related to the purchase and maintenance of robotic equipment. Further prospectively maintained or randomized data are still required to better delineate the advantages of the robotic platform, especially in the subset of most complex and technically challenging patients from both an anatomical and oncological standpoint.

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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

Cited by 89 publications

References 18 publications

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Sigmoidectomy for Diverticulitis—A Propensity-Matched Comparison of Minimally Invasive Approaches

Update on Robotic Total Mesorectal Excision for Rectal Cancer

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