Robotic versus open pancreatic surgery: a propensity score-matched cost-effectiveness analysis

Abstract

Background Robotic pancreatic surgery (RPS) is associated with high intraoperative costs compared to open pancreatic surgery (OPS). However, it remains unclear whether several advantages of RPS such as reduced surgical trauma and a shorter postoperative recovery time could lead to a reduction in total costs outweighing the intraoperative costs. The study aimed to compare patients undergoing OPS and RPS with regards to cost-effectiveness in a propensity score-matched (PSM) analysis. Methods Patients undergoing OPS and RPS between 2017 and 2019 were included in this monocentric, retrospective analysis. The controlling department provided financial data (costs and revenues, net loss/profit). A propensity score-matched analysis was performed or OPS and RPS (matching criteria: age, American society of anesthesiologists (ASA) score, gender, body mass index (BMI), and type of pancreatic resection) with a caliper 0.2. Results In total, 272 eligible OPS cases were identified, of which 252 met all inclusion criteria and were thus included in the further analysis. The RPS group contained 92 patients. The matched cohorts contained 41 patients in each group. Length of hospital stay (LOS) was significantly shorter in the RPS group (12 vs. 19 days, p = 0.003). Major postoperative morbidity (Dindo/Clavien ≥ 3a) and 90-day mortality did not differ significantly between OPS and RPS (p > 0.05). Intraoperative costs were significantly higher in the RPS group than in the OPS group (7334€ vs. 5115€, p < 0.001). This was, however, balanced by other financial categories. The overall cost-effectiveness tended to be better when comparing RPS to OPS (net profit—RPS: 57€ vs. OPS: − 2894€, p = 0.328). Binary logistic regression analysis revealed major postoperative complications, longer hospital stay, and ASA scores < 3 were linked to the risk of net loss (i.e., costs > revenue). Conclusions Surgical outcomes of RPS were similar to those of OPS. Higher intraoperative costs of RPS are outweighed by advantages in other categories of cost-effectiveness such as decreased lengths of hospital stay.

International consensus guidelines on robotic pancreatic surgery in 2023

“…Recent studies showed that RDP was cost-effective, taking into account the reduced LOH and faster functional recovery compared to ODP ( 108 - 111 ). In terms of overall costs and overall cost-effectiveness of RPS, the intraoperative cost is currently the only considered factor in the evaluation of the cost-effectiveness, however, other important factors such as social factors and personal factors should also be considered ( 112 , 113 ).…”

Pancreatic Neuroendocrine Tumors: What Is the Best Surgical Option?

“…All patients underwent surgical laparotomy or laparoscopy in order to remove the pNETs and to analyze them histologically. Open, laparoscopic, or robotic surgical choices involve enucleation, distal pancreatectomy (DP) with or without splenectomy, central pancreatectomy, pancreaticoduodenal resection (Whipple's operation) with or without pylorus preservation, and total pancreatectomy according to the primary tumor location [30][31][32].…”

Advances in pancreas surgery: robotic pancreaticoduodenectomy

“…Recurring maintenance fees and instrument costs add to the initial expenses associated with implementing a robotic surgery program [78] . Furthermore, generally longer operating times with RPD compared to open PD also drive up intraoperative costs [79,80] . However, after factoring in costs across a patient's totality of care, including post-operative care, net costs are not significantly different [79,81] .…”