Evaluating the Cost for Robotic vs “Non-Robotic” Transhiatal Esophagectomy

Abstract

Introduction This study was undertaken to analyze and compare the cost of robotic transhiatal esophagectomy (THE) to “non-robotic” THE (ie, “open” and laparoscopic). Methods With IRB approval, we prospectively followed 82 patients who underwent THE. We analyzed clinical outcomes and perioperative charges and costs associated with THE. To compare profitability, the robotic approach was analyzed against “non-robotic” approaches of THE using F-test, Mann-Whitney U test/Student’s t-test, and Fisher’s exact test. Statistical significance was reported as P ≤0.05. Data are presented as median (mean ± SD). Results 67 patients underwent the robotic approach, and 15 patients underwent “non-robotic” approach; 4 were “open” and 11 were laparoscopic. 79 patients had adenocarcinoma. Operative duration for robotic THE was 327 (331 ± 82.8) vs 213 (225 ± 62.0) minutes ( P = 0.0001) and estimated blood loss was 150 (184 ± 136.1) vs 300 (476 ± 708.7) mL ( P = 0.0001). Length of stay was 7 (11 ± 11.8) vs 8 (12 ± 10.6) days ( P = 0.76). 16 patients had post-operative complications with a Clavien-Dindo score of three or more. Hospital charges for robotic THE were $197,405 ($259,936 ± 203,630.8) vs “non-robotic” THE $159,588 ($201,565 ± $185,763.5) ( P = 0.31). Cost of care for robotic THE was $34,822 ($48,844 ± $45,832.8) vs “non-robotic” THE was $23,939 ($39,386 ± $44,827.2) ( P = 0.47). Payment received for robotic THE was $14,365 ($30,003 ± $40,874.7) vs “non-robotic” THE was $28,080 ($41,087 ± $44,509.1) ( P = 0.41). 15% of robotic operations were profitable vs 13% of “non-robotic” operations. Conclusions Patients were predominantly older overweight men who had adenocarcinoma of the esophagus. The robotic approach had increased operative time and minimal blood loss. More than a fourth of operations included concomitant procedures. Patients were discharged approximately one week after THE. Overall, the robotic approach has no apparent significant differences in charges, cost, or profitability.

Robotic-Assisted Ivor Lewis Esophagectomy Is Safe and Cost Equivalent Compared to Minimally Invasive Esophagectomy in a Tertiary Referral Center

“…A propensity-score matched study from India found significantly higher costs for RAMIE in both matched and non-matched cohorts, but also lacked a detailed cost breakdown and had a small patient sample [ 23 ]. A US study reported similar costs for RAMIE and non-robotic esophagectomy (laparoscopic or open), but the non-robotic esophagectomy group was small [ 25 ]. Therefore, to the best of our knowledge, our analysis is the first to provide a detailed financial report on RAMIE and MIE for EC/GEJ.…”

“…Most studies have reported higher financial expenses for robotic liver surgery compared to laparoscopic or open surgery [ 19 , 20 ], while others have shown equal or even lower costs [ 21 , 22 ]. Limited data is available regarding RAMIE: So far, reports from India [ 23 ], Germany [ 24 ] and the United States [ 25 ] have demonstrated higher financial expenses for RAMIE compared to MIE. Whether these cost differences can be offset by the potential benefits of RAMIE remains unclear [ 26 ].…”

The Implications of Readmission on Cost and Patient Outcomes Following Distal Pancreatectomy and Splenectomy

“…8,9 The total cost of robotic distal pancreatectomy with or without splenectomy is like or less expensive than other operations of similar complexity. [10][11][12] Regardless of this technique's initial affordability, the financial implications of readmissions may hinder its viability in comparison to other techniques. There is a complete lack of literature addressing the financial implications of readmissions following robotic distal pancreatectomy and splenectomy.…”

The future implementation of artificial intelligence technology in esophageal surgery

“…The robotic approach offers several potential benefits compared to traditional "open" and even minimally invasive laparoscopic approaches. These benefits may include improved visualization, enhanced dexterity, reduced blood loss, fewer incisions, and faster recovery times [2] . Studies have shown that, compared to non-robotic approaches, robotic THE has no apparent significant differences in charges, cost, or profitability [3] .…”