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A Contemporary Analysis of Outcomes And Cost Data In Laparoscopic and Robotic-Assisted Approaches Of Major Lung and Esophageal Surgery

Jacob A Petrosky, MD, Ellen D Vogels, DO, Jai Prasad, MD, David M Parker, MD, Marcus Fluck, James T Dove, Matthew A Facktor, MD, Jon D Gabrielsen, MD, Anthony T Petrick, MD. Geisinger Medical Center

Introduction: A New England Journal Of Medicine Analysis of 900,000 Robotic Assisted Surgery (RAS) procedures showed this approach increased costs by approximately $3,200 over Laparoscopy-Assisted (LA) surgery. We hypothesize experience has led to increased efficiency and reduced cost differential between approaches. Our objective was to contemporarily report outcomes on 30-day mortality, reoperation, total, fixed, and variable costs.

Method: 2001 patients underwent esophagus and thoracic procedures between November 2006 and July 2017. Patients were matched into cohorts by procedure type. Outcomes were analyzed using unpaired t-test and Fisher’s Exact test.

Results: Cost data was available for 447 patients undergoing RAS or LA procedures. Significant increases in equipment, labor, and overhead costs resulted with RAS vs. LA. Variable-labor and variable-overhead costs were significantly higher in LA procedures. Higher supply costs and longer procedure time was seen with RAS in all cohorts however, total 30-day costs were not significantly different in any group.

Conclusion: RAS led to significant increases in fixed, variable, and supply costs, yet overall 30-day costs were not statistically different when comparing RAS to conventional LA approaches.

Table-1.
  Esophagectomy     Major-Lung     Minor-Lung    
  LA
N=11		 RAS
N=18		 P-value LA N=297 RAS N=32 P-value LA N=63 RAS N=26  
30-day-Cost

49,777

 57,927 0.3354 27,191 21,820 0.9711 21,541 14,105 0.9748

Direct-Equipment

 1,939 2,094 0.5545 1,202 1,165 0.4107 945 708 0.0065

Direct-Labor

 3,084 3,117

0.9547

 1,466

996

 0.3352 1,159 558 0.0318

Direct-Overhead

1,591

 2,027 0.1766 861 947 0.0031 672 586 0.0904
Variable-Labor 9,768 10,844 0.5805 5,647 3,392 0.0018 4,507 1,887 0.001

Variable-Overhead
 

 3,394 3,501 0.8607 1,939 1,136 0.0013 1,584 630 0.0004

Supply

9,897

 14,480 0.0197 4,913 5,466 0.0024 3,834 4,445 0.0005

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86884

Program Number: P786

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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