Amareshewar Chiruvella, MD, Daniel Lomelin, MPH, Vishal Kothari, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center
INTRODUCTION: Robotic technology has been incorporated into the field of general surgery to help overcome the limitations of standard laparoscopy. Robot-assisted (RA) surgery has been found to be costlier than its laparoscopic counterpart. More recently, use of robot-assistance in hernia repair has been observed to be similar to standard laparoscopy in outcomes, but also being more expensive. This study examines the cost of RA inguinal (RA-IHR) and ventral (RA-VHR) hernia repair in the University HealthSystem Consortium (UHC) database to determine the specific areas of increased cost when compared to laparoscopy.
METHODS: The UHC is an alliance of more than 100 academic medical centers and 200 affiliated hospitals. Data from the Clinical Database/Resource Manager online tool was queried for encounters from 2011-2015 using the ICD-9 codes for RA and laparoscopic inguinal hernia repair (L-IHR), as well as RA and laparoscopic ventral hernia repair (L-VHR). Cost, morbidity, mortality, and readmission were examined for analysis using IBM SPSS v188.8.131.52.
RESULTS: A total of 31,183 (RA: N=842, Lap: N=30,341) patients underwent IHR while 11,351 (RA: N=375, Lap: N=10,976) had surgery for VHR. There was no difference in the morbidity (p<0.001), or readmission rates (p<0.03) between L-IHR and R-IHR groups.
Overall, the mean cost of L-IHR was $3,705 while that of RA-IHR was $5,399, representing an increase of 46%. The mean cost of L-VHR was $3,586 while that of RA-VHR was $6,377, an increase of 77%.
Cost breakdown by UHC-established service groups revealed that the primary cost differences were incurred for OR services and cost of surgical supplies. The OR services category, which includes labor, was the largest contributor to the cost increase in RA cases. OR services alone added $1,884 to the cost of RA-IHR compared to L-IHR. Likewise, these categories resulted in an additional cost of $1,672 for RA-VHR. Other categories reported by UHC include accommodations, ancillary services and anesthesia. However, the differences among these cost areas were negligibly small between laparoscopic and RA procedures.
CONCLUSIONS: While the dexterity of the robot has facilitated minimally invasive surgery across different specialties, its use has been consistently shown to incur higher costs. This study shows that the major increases in cost from robot use are found in areas such as labor, rather than supplies. Future studies need to include fixed and variable costs of new technology to better understand the ultimate utility of these devices.