Walaa F Abdelmoaty, MD, MBA1, Chris Neighorn, MBA1, Christy M Dunst, MD, FACS2, Lee L Swanstrom, MD, FACS2, Chet W Hammill, MD, MCR, FACS3. 1Providence Portland Medical Center, 2The Oregon Clinic, 3Washington University General Surgery
Introduction: The cost of introducing new surgical technologies plays an important role in their adoption. Technology with higher cost, compared to established solutions, should be justified by better outcomes or other measurable benefits. In inguinal hernia repair, the clinical benefit of robotic-assisted repair, compared to laparoscopic repair, is still debatable. Our group performed a comprehensive cost comparison between robotic-assisted and laparoscopic inguinal hernia repairs in a large healthcare system in the Western United States.
Methods and procedures: Electronic health records in 32 hospitals were queried for procedural costs of inguinal hernia repairs done between January-2015 and March-2017. Only robotic-assisted or laparoscopic unilateral inguinal hernia repairs were included. Cost calculations were done using a micro-costing methodology, a utilization based costing model. Device and maintenance costs, included in the fixed cost, were calculated to be $172 per laparoscopic case and $1272 per robotic-assisted case. These costs were derived from the purchase price, annual maintenance fees, life expectancy, and mean number of operations per year for both robotic and laparoscopic equipment. Total cost included fixed and variable costs. Other outcome measures were length of stay (LOS), conversion to open, and operative times (in-out, cut-to-close, and time in the recovery room). Statistical analysis was done using t-test for continuous variables and X2 test for categorical variables. A p-value < 0.05 was considered significant. The study was exempted from IRB approval due to the de-identified administrative nature of the data.
Results: A total of 2,405 cases; 734 robotic-assisted (633 Primary:101 recurrent) and 1671 laparoscopic (1471 Primary:200 recurrent), were included. The average total cost was significantly higher (p<0.001) in the robotic-assisted group ($5,517) compared to the laparoscopic group ($3,269). However, the average laparoscopic variable cost ($1,105) was significantly higher (p<0.001) than the robotic-assisted cost ($933). Whereas there was no significant difference between the two groups for LOS and conversion to open, average operative times were significantly higher in the robotic-assisted group (p<0.001). Subgroup analysis for primary and recurrent inguinal hernias matched the overall results.
Conclusions: Robotic-assisted inguinal hernia repair is associated with a significantly higher cost and significantly longer operative times, compared to the laparoscopic approach. The study has shown that only fixed cost contributes to the cost difference between the two approaches. Initial acquisition and maintenance costs plus the longer operative times are the main factors leading to the cost difference. Laparoscopic unilateral inguinal hernia repair is more cost-effective compared to a robotic-assisted approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87566
Program Number: S002
Presentation Session: Hernia Session
Presentation Type: Podium