Hospitalization Costs and Outcomes of Open, Laparoscopic, and Robotic Liver Resections

Abstract

Introduction Most liver resections performed in the United States are open. With the ever-increasing role of robotic surgery, our study's role is to assess national outcomes based on the surgical approach. Methods We performed a retrospective analysis of the 2015 National Readmission Database (NRD). We selected patients undergoing open, laparoscopic, and robotic hepatectomy. Propensity score matching was performed to match the three groups in terms of demographics, hospital characteristics, and resection type. Our primary outcome was 6-month readmission rates and associated costs. Results 3,872 patients were included in the analysis (open = 3,420, laparoscopic = 343, and robotic = 109). Robotic liver resection has lower 6-month readmission rates (18.3%) than the laparoscopic (26.7%) and open (30%) counterparts. The robotic approach was more cost-effective ($127,716.56 ± 12,567.31) than the open ($157,880.82 ± 18,560.2) and laparoscopic approach ($152,060.78 ± 8,890.13) in terms of the total cost which includes cost per readmission. Conclusions There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost.

An international multicenter propensity‐score matched and coarsened‐exact matched analysis comparing robotic versus laparoscopic partial liver resections of the anterolateral segments

“…Due to the inherent nature of this study, information bias and its effect on the outcomes cannot be excluded. One of the most frequently debated disadvantages of robotic surgery is the increased cost though a recent study has shown that RLR is cost‐effective 29 . As this study was multicentric, data needed for comparison of cost between the two modalities was not available and hence cost analyses could not be performed.…”

“…One of the most frequently debated disadvantages of robotic surgery is the increased cost though a recent study has shown that RLR is cost-effective. 29 As this study was multicentric, data needed for comparison of cost between the two modalities was not available and hence cost analyses could not be performed. Heterogeneity in clinical practice amongst the centers with regards to patient selection, surgical approach and techniques, and surgeon/center experience may also prove to be confounding variables in interpreting the results of this study.…”

Systematic review and meta-analysis of open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy

“…[65] However, a recent study reported that robotic liver surgery was associated with lower total costs when including cost per readmission versus its open and laparoscopic counterparts. [81] Notably, most published studies have not accounted for the considerable capital and maintenance costs of the robotic system. [75] Nevertheless, the value-outcomes plus patient experience divided by economic cost-of PLLDH/RLDH versus OLDH needs to be better understood.…”

“…One of the first comparative reports of major RLDH versus OLDH showed higher total costs for RLDH 65 . However, a recent study reported that robotic liver surgery was associated with lower total costs when including cost per readmission versus its open and laparoscopic counterparts 81 . Notably, most published studies have not accounted for the considerable capital and maintenance costs of the robotic system 75 …”

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

“…The higher costs were mostly associated with length of stay and operating room time. Another study conducted a retrospective analysis of data from the 2015 National Readmission Database in the United States [ 69 ]. Three groups were evaluated using propensity-matched analysis of open, laparoscopic, and robot-assisted resections.…”