Use of Pediatric Open, Laparoscopic and Robot-Assisted Laparoscopic Ureteral Reimplantation in the United States: 2000 to 2012

Bowen, Diana K.; Faasse, Mark A.; Liu, Dennis B.; Gong, Edward M.; Lindgren, Bruce W.; Johnson, Emilie K.

doi:10.1016/j.juro.2016.02.065

Cited by 50 publications

(28 citation statements)

References 18 publications

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“…But in terms of cost to the hospital, the advantage did not lead to cost parity across the aggregate. Bowen et al arrived at a similar finding for robotic reimplant, where, despite a significantly shorter LOS, charges for robotic surgery remained significantly higher [26]. Prolonged hospitalization in the open cohort may relate to a number of factors, including worse postoperative pain with open surgery, use of antiquated postoperative protocols for open cases, or a greater incidence of unmeasured complex cases in the open cohort.…”

Section: Discussionmentioning

confidence: 97%

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Varda

Wang

Chung

et al. 2018

Journal of Pediatric Urology

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Summary Introduction Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP. Objective To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure. Study design We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U.S. hospitalizations between 2003 and 2015. ICD9 codes and itemized billing were used to abstract our cohorts. Trends in utilization and cost were calculated and then stratified by age. We used propensity scores to weight our cohorts and then applied regression models to measure differences in the probability of prolonged operative time (pOT), prolonged length of stay (pLOS), complications, and cost. Results During the study period 11,899 pyeloplasties were performed: 75% open, 10% laparoscopic, and 15% robotic. The total number of pyeloplasty cases decreased by 7% annually; OP decreased by a rate of 10% while RP grew by 29% annually. In 2015, RP accounted for 40% of cases. The largest growth in RPs was among children and adolescents. The average annual rate of change in cost for RP and OP was near stagnant: −0.5% for open and −0.2% for robotic. The summary table provides results from our regression analyses. RP conferred an increased likelihood of pOT, but a reduced likelihood of pLOS. The odds of complications were equivalent. RP was associated with a significantly higher median cost, but the absolute difference per case was $1060. Discussion Despite advantages in room and board costs for RP, we found that the cost of equipment and OR time continue to make it more expensive. Although the absolute difference may be nominal, we likely underestimate the true cost because we did not capture amortization, hidden or down-stream costs. In addition, we did not measure patient satisfaction and pain control, which may provide the non-monetary data needed for comparative value. Conclusion Despite an overall decline in pyeloplasties, RP utilization continues to increase. There has been little change in cost over time, and RP remains more expensive because of equipment and OR costs. The robotic approach confers a reduced likelihood of pLOS, but an increased likelihood of pOT. Complication rates are low and similar in each cohort.

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Section: Discussionmentioning

confidence: 97%

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Varda

Wang

Chung

et al. 2018

Journal of Pediatric Urology

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“…A shorter hospital stay was also observed when RP was compared with OP in a national assessment of USA children, and in a meta‐analysis comparing RP, LP and OP by Cundy et al . Similar convalescence trends were observed in a national assessment of RUR, in addition to an overall increased prevalence of the technique from 2009 to 2012 . In order to actualize these benefits, it is critical to implement a well‐structured plan.…”

Section: Introductionmentioning

confidence: 63%

Setting up a pediatric robotic urology program: A USA institution experience

et al. 2017

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Implementing a robotic urological surgery program requires institutional support, and necessitates a comprehensive, detail-oriented plan that accounts for training, oversight, cost and case volume. Given the prevalence of robotic surgery in adult urology, in many instances it might be feasible to implement a pediatric robotic urology program within the greater context of adult urology. This involves, from an institutional standpoint, proportional distribution of equipment cost and operating room time. However, the pediatric urology team primarily determines goals for volume expansion, operative case selection, resident training and surgical innovation within the specialty. In addition to the clinical model, a robust economic model that includes marketing must be present. This review specifically highlights these factors in relationship to establishing and maintaining a pediatric robotic urology program. In addition, we share our data involving robot use over the program's first nine years

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“…Bowen et al [32] recently analyzed the use of pediatric open, laparoscopic and RALUR in the United States from 2002 to 2012. The number of annual ureteral reimplantations decreased by 14.3% during this time period, but the minimally invasive ureteral reimplantations increased from 0.3% in 2000 to 6.3% in 2012.…”

Section: The Prevalence Of Ralur During the Last Decadementioning

confidence: 99%

“…Concerns have been raised as to whether RALUR is a cost-effective option when compared to open surgery due to its high capital costs and heterogeneous clinical outcomes, and several recent studies have attempted to compare the costs between RALUR and open ureteral reimplantation [325051]. However, while the estimation of actual costs can be difficult, the overall conclusions from these studies noted that the direct cost including operating room charges may be higher for RALUR, but the shorter hospital length of stay with lower hospitalization charges can result in equivalent total charges in comparison with open ureteral reimplantation.…”

Section: Extravesical Approachmentioning

confidence: 99%

Lessons learned over a decade of pediatric robotic ureteral reimplantation

Baek

Koh

2017

Investig Clin Urol

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The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.

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Use of Pediatric Open, Laparoscopic and Robot-Assisted Laparoscopic Ureteral Reimplantation in the United States: 2000 to 2012

Cited by 50 publications

References 18 publications

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015

Setting up a pediatric robotic urology program: A USA institution experience

Lessons learned over a decade of pediatric robotic ureteral reimplantation

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