Robotic Versus Laparoscopic Cholecystectomy: Does the End Justify the Means?

Jan P Kaminski, MD, MBA, Kenneth W Bueltmann, MD, Marek Rudnicki, MD, PhD. University of Illinois Metropolitan Group Hospitals.

INTRODUCTION: Robotic-assisted cholecystectomy (RAC) was introduced about five years ago, and has recently gained popularity in general surgery as more surgeons have become familiar with the technique. High cost of the procedure seems to affect its widespread utilization. With its more extensive use by experienced surgeons familiar with this procedure, cost of RAC might be more controlled with similar outcomes.

METHODS AND PROCEDURES: The Nationwide Inpatient Sample (NIS) from the Health Cost Utilization Project was analyzed using HCUPnet, NIS datasets and SAS 9.2 for the years 2010 – 2011. Queries were made for RAC and LC (ICD-9 17.42+51.23, 51.23) procedures with a primary diagnosis of gallbladder disease (ICD-9 574.0-574.9, 575.0-575.9, 575.12). The NIS weighting algorithm was used for National estimates. Overall charges, costs, number of chronic conditions and lengths of stay were calculated. The NIS Z-score calculator was utilized for all statistics.

RESULTS: Total number of RAC and LC in the NIS database for years 2010 and 2011 are shown in the table. The incidence of RAC more than doubled between 2010 and 2011. Total costs for LC increased by 2.5% (p < 0.05) while total costs for RAC decreased by 14.6% (p = 0.27) between 2010 and 2011, even though RAC was still costlier than LC in 2011. The estimated cost differences between RAC and LC in 2010 and 2011 were $7,518, +54%, (p < 0.05) and $4,044, +29%, (p < 0.05). The total charge of LC increased by 8% (p < 0.05) between 2010 and 2011, while the total charge for RAC increased by 13.3% (p = 0.33). Total charge difference between RAC and LC in 2010 and 2011 were $19,719, +47%, (p < 0.05) and $24,526, +54%, (p < 0.05) respectively. There was no significant difference in the LOS between RAC and LC in either years. Interestingly, the patients undergoing RAC had an increased number of chronic conditions compared to patients undergoing LC in both 2010 and 2011.
 

CONCLUSION: The number of RAC is increasing in the United States. Outcomes of RAC, as measured by one available indicator, LOS, are similar to LC. Cost of RAC however remains higher compared to LC although there was noticeable reduction in cost of RAC in 2011 versus 2010. It would be very interesting to continue an observation of these trends since current cost of RAC might prohibit its more widespread use among laparoscopic surgeons.