Cost-Benefit Analysis of Robotic vs. Laparoscopic Hepatectomy: A Propensity-Matched Retrospective Cohort Study of American College of Surgeons National Surgical Quality Improvement Program Database
| Autor: | Alec S Kellish, Francis Spitz, Abraham Hakim, Umur Atabek, John P. Gaughan, Henry Miller, Young K Hong, Marisa Wozniak, Richard Sensenig |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Cost-Benefit Analysis Laparoscopic hepatectomy Medicare 03 medical and health sciences 0302 clinical medicine Robotic Surgical Procedures Humans Hepatectomy Medicine Robotic surgery Aged Retrospective Studies Surgeons Cost–benefit analysis business.industry General surgery Retrospective cohort study General Medicine Length of Stay Quality Improvement United States Acs nsqip 030220 oncology & carcinogenesis Laparoscopy 030211 gastroenterology & hepatology business |
| Zdroj: | The American Surgeon. 88:2886-2892 |
| ISSN: | 1555-9823 0003-1348 |
| Popis: | Background Robotic and laparoscopic hepatectomies having increased utilization as minimally invasive techniques are explored for hepatobiliary malignancies. Although the data on outcomes from these 2 approaches are emerging, the cost-benefit analysis of these approaches remains sparse. This study compares the costs associated with robotic vs. laparoscopic liver resections, taking into account 30-day complications. Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014 and 2017 was identified. Costs were assigned to perioperative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from the Centers for Medicare and Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data. Results In our matched cohort of 454 patients (227 per group), total costs associated with laparoscopic liver resections were estimated at $5.5 M ($24 K per patient) vs. $6.8 M ($29.8 K per patient) for robotic liver resections (21.3% difference, P < .001). The higher cost associated with robotic hepatectomies was related to blood transfusions ($22.0 K vs. $12.1 K, P = .02), length of stay ($2.05 M vs. $1.76 M, P = .046), and OR time ($4.01 M vs. $3.24 M, P < .0001). Discussion Robotic hepatectomies were associated with higher costs compared to laparoscopic hepatectomies. The 2 major contributors to the cost disparity were increased OR time and increased length of stay. Future studies are warranted to analyze high-volume Minimally Invasive Surgery surgeons’ impact in specialty centers on potentially mitigating this current cost disparity. |
| Databáze: | OpenAIRE |
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