da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs

Abstract

Purpose: To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. Methods: Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. Results: Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). Conclusions: The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.

First Experiences with the New Senhance® Telerobotic System in Visceral Surgery

“…In 1997, a cholecystectomy was the first robotic-assisted surgery performed in Belgium. Robotic-assisted surgery was shaped by the then only system available - the DaVinci® surgical system (Intuitive Surgical, Sunnyvale, CA, USA) [2]. Because of the high and unreimbursed costs and the comparably long process times, robotic-assisted operations have only become established in urological surgery.…”

Association between the Surgical Apgar Score and Perioperative Complications after Radical Prostatectomy

“…Applying a standardized reporting methodology, like the modified Clavien-Dindo classification (CDC) [1], it is found that the overall complication rate of the procedure can be as high as 42.5% [2] . Easily applicable objective models that evaluate the postoperative risk of morbidity and mortality of radical prostatectomy are rare.…”

On Robots and Insurance

“…Searching in the literature, the most recurrent issues concerning surgical robots and insurance are about the coverage of specific surgical interventions by the national health insurance service [39,40] and about the reduced health insurance costs resulting from robotic assisted surgery [41]. These issues are relevant also for other medical applications of robots, such as prosthetic devices, as reported by [2].…”