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.
| 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