Bhavani Pokala1, Laura Flores2, Priscila R Armijo3, Vishal Kothari1, Dmitry Oleynikov4. 1. University of Nebraska Medical Center, Department of Surgery, General Surgery, Omaha, NE, USA; Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA. 2. University of Nebraska Medical Center, College of Medicine, Omaha, NE, USA. 3. Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA. 4. University of Nebraska Medical Center, Department of Surgery, General Surgery, Omaha, NE, USA; Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: doleynik@icloud.com.
Abstract
BACKGROUND: This study sought to evaluate surgical outcomes, cost, and opiate utilization of patients who underwent laparoscopic (LC) or robotic cholecystectomy (RC). METHODS: The Vizient database was queried for patients admitted with mild to moderate severity of illness (SOI) scores who underwent LC or RC from January 2015 through December 2017. Rates of overall complications, postoperative infection, mortality, LOS, cost, and opiate utilization were compared between groups using IBM SPSS v.25.0, α = 0.05. RESULTS: 91,849 patients (LC:N = 89,878; RC:N = 1,971) met the inclusion criteria. Robotic approach was associated with more complications (LC:0.9%, RC:1.7%; p < 0.001), postoperative infections (LC:0.2%, RC:0.4%; p = 0.033) and a higher direct cost (LC:$6782 ± 3421, RC:$9354 ± 5497; p < 0.001). Opiates were prescribed more frequently in the laparoscopic group (LC:98.3%, RC:97.2%; p = 0.002). CONCLUSION: The direct cost of RC is significantly higher than LC with no added benefit. Routine use of the robotic platform for cholecystectomy should be discouraged until costs are reduced.
BACKGROUND: This study sought to evaluate surgical outcomes, cost, and opiate utilization of patients who underwent laparoscopic (LC) or robotic cholecystectomy (RC). METHODS: The Vizient database was queried for patients admitted with mild to moderate severity of illness (SOI) scores who underwent LC or RC from January 2015 through December 2017. Rates of overall complications, postoperative infection, mortality, LOS, cost, and opiate utilization were compared between groups using IBM SPSS v.25.0, α = 0.05. RESULTS: 91,849 patients (LC:N = 89,878; RC:N = 1,971) met the inclusion criteria. Robotic approach was associated with more complications (LC:0.9%, RC:1.7%; p < 0.001), postoperative infections (LC:0.2%, RC:0.4%; p = 0.033) and a higher direct cost (LC:$6782 ± 3421, RC:$9354 ± 5497; p < 0.001). Opiates were prescribed more frequently in the laparoscopic group (LC:98.3%, RC:97.2%; p = 0.002). CONCLUSION: The direct cost of RC is significantly higher than LC with no added benefit. Routine use of the robotic platform for cholecystectomy should be discouraged until costs are reduced.
Authors: Rivfka Shenoy; Michael A Mederos; Linda Ye; Selene S Mak; Meron M Begashaw; Marika S Booth; Paul G Shekelle; Mark Wilson; William Gunnar; Melinda Maggard-Gibbons; Mark D Girgis Journal: Syst Rev Date: 2021-04-23