Andrew Lekarczyk1, Hana Sinha1, Danielle Dvir1, Joshua Goyert1, Austin Airhart1, Rishindra M Reddy2,3. 1. University of Michigan Medical School, Ann Arbor, MI, 48109, USA. 2. University of Michigan Medical School, Ann Arbor, MI, 48109, USA. reddyrm@med.umich.edu. 3. Section of Thoracic Surgery, Department of Surgery, University of Michigan-Comprehensive Robotic Surgery Program, Jose Jose Alvarez Research Professor in Thoracic Surgery, University of Michigan, TC2120/5344, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA. reddyrm@med.umich.edu.
Abstract
INTRODUCTION: Robotic-assisted laparoscopic surgery has emerged as an alternative to traditional laparoscopy and may offer some clinical benefits when performing complex hiatal hernia repairs. Many institutions may choose to not invest in robotic surgery because of perceived higher costs, and when they already have proficient laparoscopic surgeons. We hypothesized that the robotic approach would yield lower profits overall due to higher supply costs, while offering comparable outcomes to the traditional laparoscopic approach. METHODS: Financial and outcomes data from a single quaternary academic center was retrospectively reviewed from a prospectively collected database from July 2020 to May 2021. Laparoscopic hiatal hernia repairs and robotic-assisted repairs were compared for metrics including length of stay, operative time, hospital and supply cost, payments, and profits. Metrics of these two groups were compared using t-test analyses with significance set to p < 0.05. RESULTS: Seventy-three patients were included with 31 in the robotic group (42.5%) and 42 in the laparoscopic group (57.5%). There were no significant differences in length of stay (robotic mean 2.0 days, laparoscopic 2.55 days, p = 0.09) or operative time (257.6 min vs 256.7 min, p = 0.48) between the two approaches. The robotic approach was associated with higher supply costs ($2,655 vs $2,028, p < 0.001) and patient charges ($63,997 vs $56,276, p < 0.05). Despite higher costs associated with robotics, hospital profits were not different between the two groups ($7,462 vs $7,939, p = 0.42). CONCLUSION: Despite higher supply costs and charges for robotic-assisted hiatal hernia repair, hospital profits were similar when comparing robotic and laparoscopic approaches. Short-term clinical outcomes were also similar. Programs should do their own analysis to understand their individual cost issues.
INTRODUCTION: Robotic-assisted laparoscopic surgery has emerged as an alternative to traditional laparoscopy and may offer some clinical benefits when performing complex hiatal hernia repairs. Many institutions may choose to not invest in robotic surgery because of perceived higher costs, and when they already have proficient laparoscopic surgeons. We hypothesized that the robotic approach would yield lower profits overall due to higher supply costs, while offering comparable outcomes to the traditional laparoscopic approach. METHODS: Financial and outcomes data from a single quaternary academic center was retrospectively reviewed from a prospectively collected database from July 2020 to May 2021. Laparoscopic hiatal hernia repairs and robotic-assisted repairs were compared for metrics including length of stay, operative time, hospital and supply cost, payments, and profits. Metrics of these two groups were compared using t-test analyses with significance set to p < 0.05. RESULTS: Seventy-three patients were included with 31 in the robotic group (42.5%) and 42 in the laparoscopic group (57.5%). There were no significant differences in length of stay (robotic mean 2.0 days, laparoscopic 2.55 days, p = 0.09) or operative time (257.6 min vs 256.7 min, p = 0.48) between the two approaches. The robotic approach was associated with higher supply costs ($2,655 vs $2,028, p < 0.001) and patient charges ($63,997 vs $56,276, p < 0.05). Despite higher costs associated with robotics, hospital profits were not different between the two groups ($7,462 vs $7,939, p = 0.42). CONCLUSION: Despite higher supply costs and charges for robotic-assisted hiatal hernia repair, hospital profits were similar when comparing robotic and laparoscopic approaches. Short-term clinical outcomes were also similar. Programs should do their own analysis to understand their individual cost issues.
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