National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations

Ng, Ayesha P.; Sanaiha, Yas; Bakhtiyar, Syed Shahyan; Ebrahimian, Shayan; Branche, Corynn; Benharash, Peyman

doi:10.1016/j.surg.2023.02.016

Cited by 21 publications

(13 citation statements)

References 23 publications

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“…The cost-effectiveness of the robotic platform over laparoscopy is debated, yet literature has consistently found robotic surgery to cost more than laparoscopy. [18][19][20][21][22][23] The robotic platform however has some advantages. It has been shown to have a lower rate of conversion to open surgery when compared to laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Sibia,

Klune,

Saiolghalam

et al. 2024

The American Surgeon™

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Background Bundled Payment (BP) models are becoming more common in surgery. We share our early experiences with Bundled Payments for Care Improvement for major bowel surgery. Methods Patients undergoing major bowel surgery between January and October 2021 were identified using Medicare Severity-Diagnosis Related Group (MS-DRG) codes. Major drivers of cost in a BP model are reported and compared to the Fee-For-Service (FFS) payment model. Results A total of 202 cases (173 FFS vs 29 BP) were analyzed. The mean BP cost per Clinical Episode was $28,340. Eleven patients (38%) in the BP model had costs greater than the Target Price. The drivers of cost in the BP model were 59% acute care facility, 17% physician services, 9% post-acute care facilities, 8% other, and 7% readmissions. Clinical Episode of care costs varied considerably by MS-DRG case complexity. Robotic surgery increased costs by 35% (mean increase $3724, P < .01). The 90-day readmission rate was 17% for a mean cost of $11,332 per readmission. Three patients (10%) were discharged to a skilled nursing facility at an average cost of $11,009, while fifteen patients (52%) received home health services at a mean cost of $2947. Acute care facility costs were similar in the BP vs FFS groups (mean difference $1333, P = .22). Conclusions Patients undergoing major bowel surgery are a heterogeneous population. Physicians are ideally positioned to deliver high-value, patient-centered care and are crucial to the success of a BP model. The post-acute care setting is a key component of improving efficiency and quality of care.

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Section: Discussionmentioning

confidence: 99%

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Sibia,

Klune,

Saiolghalam

et al. 2024

The American Surgeon™

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“…The results from our analysis revealed a slightly younger population receiving robotic THA. Perhaps this reflects an inverse relation between acceptance of this technology and age [ 7 , 12 - 15 ]. Women have proportionately dominated both groups with higher prevalence in the present paper, and this aligns with previously published series [ 7 , 12 - 14 ].…”

Section: Discussionmentioning

confidence: 99%

Lower Intraoperative and Immediate Postoperative Complications in Robotic Versus Conventional Primary Total Hip Arthroplasty: A Retrospective Cohort Analysis of Over 360,000 Patients

Khanna,

Sohn,

Khanna

et al. 2024

Cureus

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Purpose: Although a trend of an improved alignment with robotic total hip arthroplasty (THA) over conventional methods has surfaced from recent series, it is unknown whether these results translate into meaningful enhancements in postoperative outcomes. To address this lack in the literature, we compared the perioperative morbidity and mortality with robotic and conventional THA in a large national cohort of 367,894 patients. We hypothesized that no significant differences would exist in the outcomes between the two groups. Methods: Records were extracted from 2016-2019 from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project which is the largest in-patient database in the United States. From 367,894 THAs, robotics were employed for 7,863 patients. The remaining 360,031 conventional THAs served as controls. The two groups were compared for demographics, admission, and hospital stay details including costs, and mortality and morbidity data including medical and surgical complications. Descriptive statistics were used for demographic data while analytical statistics including t-tests, chi-squared tests, Fischer exact test, and Pearson chi-squared tests were used for perioperative outcomes. Statistical significance was set at p<0.005. Results: Demographic distributions between robotic and conventional THA groups displayed similar age and sex characteristics. Shorter mean lengths of stay (1.87 days) were seen in robotic THA versus conventional THA (2.33 days) while higher costs were noted for the former (mean $68,686.71 vs $66,840.39) (p<0.005). Low overall mortality (0.03% robotic, 0.09% conventional) was seen in both groups (p>0.005). Higher comparative incidences of anemia, acute renal failure, and pneumonia were seen in conventional THA (p<0.005) while no significant differences were noted for other complications including myocardial infarction, pulmonary embolism, deep vein thrombosis, and cardiac arrest (p>0.005). Among others, lower dislocation rates, mechanical complications, periprosthetic joint infection, and periprosthetic fractures were seen with robotic THA (p<0.005). Wound complications and superficial infection rates did not differ between the two groups (p>0.005). Conclusions: Evidence has emerged from our results to support more routine adaptation of the robotic option of performing a THA. These can be based on lower local, systemic, and mechanical complications as demonstrated by the present study. Further evaluation of these results in follow-up would help establish the foothold of robotic surgery in total hip replacement in the modern context.

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“… 62 While it is often cited that the lower complication rate and shorter hospital stay offset the high cost of robotic procedures, the data supporting this assertation is variable. 4 , 63 Certain novel robotic systems aim to offer lower cost options; the Revo-i system claims a 42% cost reduction when compared with the da Vinci, 15 while the Avatera’s use of single-use instruments eliminates sterilization costs. 56 The Senhance system allows for incorporation of traditional laparoscopic instruments, which are less costly than robotic instruments, and the system is less expensive to maintain than the da Vinci.…”

Section: Discussionmentioning

confidence: 99%

“…2 Roboticassisted surgery is more costly upfront than the laparoscopic or open alternative, although the decrease in complication rate and shorter length of hospital stay is thought to offset the higher cost at least partially. 4,5 As of the third quarter of 2022, there were 7364 da Vinci surgical systems installed worldwide, an increase of 13% from 1-year prior. 6 Procedures grew by approximately 20% in the same year, resulting in a quarterly revenue of $1.56 billion.…”

Section: Introductionmentioning

confidence: 99%

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New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology

Salkowski,

Checcucci,

Chow

et al. 2023

Therapeutic Advances in Urology

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Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system.

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National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations

Cited by 21 publications

References 23 publications

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery

Lower Intraoperative and Immediate Postoperative Complications in Robotic Versus Conventional Primary Total Hip Arthroplasty: A Retrospective Cohort Analysis of Over 360,000 Patients

New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology

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