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To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after Enhanced Recovery After Surgery (ERAS) implementation.This retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost-to-charge ratios and reimbursement rates and adjusted for variables expected to impact costs. Secondary outcomes included narcotic use, length of stay (LOS), and complications from index hospitalization to postoperative day 30.For the total 231 patients (open cohort, 90; robotic cohort, 141), adjusted mean cost of robotic surgery was $3,239 higher compared to open sacrocolpopexy (95% CI, $1,331-$5,147; P.001). Rates were not significantly different for intraoperative complications (robotic, 4.3% [6/141]; open, 5.6% [5/90]; P=.754); 30-day postoperative complications (robotic, 11.4% [16/141]; open, 16.7% [15/90]; P=.322); or readmissions (robotic, 5.7% [8/141]; open, 3.3% [3/90]; P=.535). The percentage of patients dismissed on postoperative day 1 was greater in the robotic group (89.4% [126/141] vs 48.9% [44/90], P.001).Decreased LOS associated with ERAS provided significant cost savings with open sacrocolpopexy vs robotic sacrocolpopexy without adverse impacts on perioperative complications or readmissions. |
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