The Presence of a Cost–Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections

Abstract

Objective: To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs. Background: The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking. Methods: Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions. Results: An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P<0.001), as well as significantly reduced length of stay (−0.8 d, P<0.001) and costs (−$3900, P<0.001). Conclusions: Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.

Association of Center-Level Operative Volume and Acute Outcomes following Robotic-Assisted Colectomy for Malignancy

“…Previous studies have reported high overall robotic-assisted surgical volume to be associated with reduced costs for cancer surgery, including lobectomy, pancreaticoduodenectomy and prostatectomy. 11,12,18,19 In the present work on RAC, we found that an increase in the number of all robotic operations performed at a center was associated with decreased index hospitalization costs. This finding may be explained by the fact that centers with a high robotic operation volume also tend to be high-volume colectomy institutions.…”

“…10 Prior work has revealed higher center-specific robotic surgical volume to be associated with lower costs for various cancer operations including lobectomy and pancreaticoduodenectomy. 11,12 Specifically, an increase in the overall robotic-assisted caseloads have been shown to reduce operative times and postoperative length of stay. 10 However, there is a paucity of data regarding the definition of high-volume for RAC as well as its associated cost-volume outcome relationship.…”