Rana M Higgins, MD, Matthew J Frelich, MS, Matthew E Bosler, BA, Jon C Gould, MD. Medical College of Wisconsin
Introduction: Robotic surgical systems have been used at a rapidly increasing rate in general surgery for procedures that have traditionally been performed laparoscopically. The potential increased cost of a robotic compared to laparoscopic approach is concerning in this era of increased attention to health care costs. In a surgical encounter, a significant portion of total costs is associated with consumable supplies. Our hospital system has invested in a software program that can track costs of consumable surgical supplies by procedure. We sought to determine the differences in cost of consumables with laparoscopic and robotic general surgery procedures.
Methods: De-identified procedural cost and equipment utilization data were collected from the Surgical Profitability Compass Procedure Cost Manager System (The Advisory Board Company, Washington DC) for our health care system for laparoscopic and robotic cholecystectomy, hiatal hernia repair and Nissen fundoplication, and inguinal hernia between the years 2013-2015. Outcomes measured were supply cost, length of stay, and case duration. Statistical analysis was performed using t-test for continuous variables and statistical significance defined as p < 0.05.
Results: The total cost of consumable surgical supplies was significantly greater for robotic versus laparoscopic cases for all procedures analyzed (Table 1). Length of stay did not differ by technique. Case duration was similar for laparoscopic and robotic cholecystectomy (75.5 and 83.9 minutes, p=0.10), but significantly less for laparoscopic versus robotic hiatal hernia repair and Nissen fundoplication (162.1 and 196 minutes, p<0.01) and inguinal hernia (81.3 and 124 minutes, p<0.01).
| Cholecystectomy | Hiatal hernia and Nissen fundoplication | Inguinal hernia | |
| Robotic | $1,712 (n=37) | $4,124 (n=21) | $1,954 (n=12) |
| Laparoscopic | $631 (n=343) | $1,918 (n=114) | $1,472 (n=272) |
| p-value | <0.01 | <0.01 | <0.01 |
Conclusion: We found a significantly increased cost of general surgery procedures for our health care system when cases commonly performed laparoscopically are performed robotically. Our analysis is limited in that it included costs associated with consumable surgical supplies. The initial acquisition cost, depreciation, and service contract for the robotic and laparoscopic systems were not included in this analysis. Unless a significant patient-centered clinical outcome advantage can be identified for the robotic approach in these selected general surgery procedures, we believe that the robotic approach is not an effective use of our limited health care dollars.