Matthew S Surrusco, MD1, Joshua Farnsworth, BS2, Xian Luo-Owen, PhD2, Esther Wu, MD2, Daniel P Srikureja, MD2, Kaushik Mukherjee, MD, MSCI, FACS2. 1University of Florida School of Medicine, 2Loma Linda University School of Medicine
OBJECTIVES: To determine if the use of the surgical robot can add value to the Acute Care Surgery service at a busy academic hospital by studying OR time, length of stay, complications, and hospital costs.
METHODS: We reviewed a prospectively collected Acute Care Surgery registry at a large (>500 bed) adult university hospital over 9 months. Cases from two acute care surgeons with privileges for open, laparoscopic, and robotic cases were included. Operative technique (laparoscopic versus robotic) could not be randomized as trained robotic personnel are available only on weekdays. We collected data on demographics, indication for surgery, nutritional status, comorbidities, OR time, postoperative complications, length of stay, and costs from the day of surgery until discharge. We analyzed our data in SPSS 22 (IBM Inc., Armonk NY) and utilized Student’s T test and Chi-Square. We also performed a linear regression analysis to determine the effect of OR time, robotic surgery, and diagnosis on operating room costs and postoperative length of stay.
RESULTS: 37 laparoscopic and 14 robotic cholecystectomies were performed. Demographic parameters (age, gender, medical comorbidities, preoperative albumin and BMI, surgical history and smoking) were comparable. Primary diagnosis was significantly different (Chi-square 0.05), driven by more acute cholecystitis in the laparoscopic group. 0/14 robotic cases and 5/37 (13.5%, p = 0.305) laparoscopic cases were converted to open (2 for adhesions, 2 for failure to progress, and 1 for visualization of anatomy). There was no difference in the incidence of postoperative complications. Operative time was similar (158±38 min [robot]vs. 135±62 min [lap], p = 0.125). There was a trend toward shorter postoperative length of stay in the robotic group (1.4±1.4 days vs. 2.4±2.6 days, p = 0.087) but this was not significant even after adjusting for OR time and diagnosis. Robotic procedures had higher unadjusted OR costs ($3490±$934 vs. $2190±$831, p < 0.001). After adjusting for OR time and diagnosis, robotic surgery was associated with a $980 increase in costs [95%CI $648, $1310, p < 0.001].
CONCLUSIONS: Robotic cholecystectomy can be safely performed on an ACS service with minimal risk of conversion. Robotic surgery is independently associated with increased OR cost, but individual hospital systems must decide if this additional cost outweighs increased robot utilization and training benefits for physicians and staff.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86630
Program Number: P775
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster