Ellen Vogels, DO, May David, DO, Darron McField, MD, Mark Jayanathan, MD, James Dove, Fluck Marcus, David Parker, MD, Jon Gabrielsen, MD, Anthony Petrick, MD. Geisinger Medical Center
INTRODUCTION: Our objective was to assess cost of shifting ambulatory surgery cases (ASC) to a robotic hospital-based platform.
METHODS AND PROCEDURES: This was a retrospective review of cholecystectomy (CCY) or initial unilateral inguinal hernia repair (IHxR) patients from January 2007-August 2016 who met ambulatory surgery center criteria. Age, Charlson score, procedure length, 30-day readmissions and mortality, variable and total costs were analysed.
RESULTS: The IHxR group included hospital laparoscopic (HLH), hospital open (HOH), robotic (HRH), ambulatory center laparoscopic (ASCLH), and ambulatory center open (ASCOH. [Table 1]. HRH repairs took significantly longer with significantly higher variable and total costs. The CCY group included hospital laparoscopic (HLC), hospital robotic (HRC)and ambulatory surgery center laparoscopic (ASCLC) [ Table 2]. CCY took longer in HRC patients and both variable and total cost were significantly higher (p <0.0001). Age, BMI and Charlson scores were not significantly higher for the robotic group.There were no significant differences in readmission rates and no 30-day mortality.
CONCLUSIONS Capital costs do not fully capture those associated with the sharp increase in robotic CCY and IhxR. The cost of HRC was nearly double that of HLC or ASCLC. An ASC was the least costly platform for IhxR regardless of surgical approach while ASCOH was 1/3 the cost of HRH. There are about 425,000 ASC-eligible patients undergoing these procedures annually in the US with the potential additional costs, largely borne by hospitals and health systems, exceeding $1 billion.
| (n=) | HLH (59) | HOH (421) | HRH (19) | ASCLH (37) | ASCOH (187) | p |
| Surgery Duration (min) | 78 (31) | 64 (28) | 109(29) | 62 (24) | 59 (21) | <0.001 |
| Variable Costs (US$-sd) | $2,345 (571) | $1,311 (636) | $3,066 (440) | $1,940 (932) | $924 (318) | <0.001 |
| Total Costs (US$-sd) | $4,475 (1004) | $2,782 (1201) | $6,292 (769) | $3,421 (1439) | $1,853 (534) | <0.001 |
| (n=) | HLC (1004) | HRC (31) | ASCLC (213) | p |
| Surgery Duration (min) | 59.8 (24.4) | 72.8 (23.5) | 45.7 (14.4) | <0.001 |
| Variable Costs (US$-sd | $1589 (286) | $3024 (749) | $1878 (787) | <0.001 |
| Total Costs (US$-sd) | $3270 (577) | $6057 (1312) | $3443 (1274) | <0.001 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80407
Program Number: S070
Presentation Session: Robotics
Presentation Type: Podium