Chetna Bakshi, MD1, Andrew Godwin2, Seungjun Ahn3, Kevin Hutchings4, Julio Teixeira4. 1General Surgery at Northwell Health, 2MIS Fellow at Lenox Hill Hospital, 3Feinstein Institute for Medical Research, 4Lenox Hill Hospital
Background: Use of the Da Vinci robot system is increasing in the field of bariatric surgery. Questions that remain unanswered are the clinical impact on outcomes, and the impact of cost. Our study was to evaluate the economic impact of robotics in bariatric surgery.
Methods: We retrospectively analyzed bariatric operations done at our institution from January 2016 through June 2017. We analyzed the cost of conventional laparoscopy versus robot assisted procedures including operative time, operating room costs, length of stay, and overall hospital expenses. In addition, we looked at the reimbursements for laparoscopic versus robotic surgeries as well as the contribution margin based on cpt code.
Results: Our study included a total of 492 bariatric patients who underwent 422 laparoscopic and 70 robot assisted operations including sleeve gastrectomy and bypasses. A cohort analysis demonstrated baseline similarities in BMI and comorbidities with the exception of patients with COPD who were more likely to undergo robot assisted surgery. In addition, the average length of hospital stay did not significantly differ. The average time duration for laparoscopic sleeve gastrectomy was 127 minutes vs 174 minutes for robot assisted. We performed a cost analysis which showed an average total cost of $7,024 for laparoscopic sleeve gastrectomy and an average of $11,680 for robotic assisted. The total reimbursements were $21,587 for laparoscopic sleeve gastrectomy and $18,310 for robot assisted. This translated to an average contribution margin of $14,564 for laparoscopic vs $6,630 for robot assisted. We analyzed these differences for bypasses as well. Laparoscopic bypasses averaged 193 minutes laparoscopically vs 330 robotically. We found an average cost of laparoscopic $11,366 vs robot assisted $17,032, with a contribution margin of $13,734 laparoscopic vs $5,701 robot assisted.
Conclusions: In our study we noted increased operative times with robot assisted operations, especially bypasses which could be explained by increased use of the robotic system for difficult cases such as revisional bypasses. The impact of cost is especially important in this financial climate, and judicious use of resources becomes important when determining surgical approach. In our experience the contribution margin is lower with robot assisted surgery as compared to conventional laparoscopy. Though the cost of robot assisted surgery may decrease with time, patient selection, complication rates, patient safety, and surgeon ergonomics will play an important role in determining when to perform robot assisted surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88364
Program Number: P792
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster