Chetna Bakshi, MD1, Andrew Godwin, MD2, Julio Teixeira, MD3. 1General Surgery at Northwell Health, 2MIS Fellow at Lenox Hill Hospital, 3Lenox Hill Hospital
Background: Robotic surgery has made a large impact in the fields of urology and gynecology. Its use is significantly increasing in the fields of general and bariatric surgery. Evidence remains unclear as to the clinical impact on outcomes, and significant questions remain as to the impact of cost. Our goal was to evaluate the economic impact of robotic surgeries in general and bariatric surgery at our institution.
Methods: This study is a retrospective analysis of minimally invasive general and bariatric procedures done at a single institution from January 2016 through June 2017. We performed a cost and reimbursement analysis of robotic versus conventional laparoscopic surgery. The cost evaluation included operative time, operating room costs, length of stay and overall hospital expenses. In addition, we looked at reimbursement and the contribution margin per cpt code.
Results: Our study included a total of 1927 patients who underwent 1716 laparoscopic and 211 robot assisted general and bariatric surgeries. The average time duration for laparoscopic surgeries was 138 minutes vs 248 minutes for robot assisted. We performed a cost analysis which showed an average total cost of $8,955 for laparoscopic and an average of $15,319 for robot assisted. The total reimbursements were $19,631 for laparoscopic and $21,949 for robot assisted. This translated to an average contribution margin of $10,676 for laparoscopic vs $6,630 for robot assisted. For general surgery we found an average cost of laparoscopic $7,675 vs robot assisted $9,436, with a contribution margin of $7,761 laparoscopic vs $3,473 robot assisted. For bariatric surgeries we found an average contribution margin of $14,149 for laparoscopic vs $6,165 for robot assisted.
Conclusions: Robotic surgery has been associated with higher costs and longer operative times. In this economic climate of increased cost awareness with institutions under increasing financial pressures, judicious use of resources becomes important when determining surgical approach. Although cost of robot assisted surgery may decrease with time, other quality factors may be important in patient selection. Although there is no clear evidence that institutions lose money with robot assisted surgery, in our experience the contribution margin is lower with robot assisted surgery as compared to conventional laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88358
Program Number: P774
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster