Analysis Of Temporal Trends In Robotic Surgery Costs Using The Outpatient Inguinal Hernia Repair Model.
*Haroon M Janjua, *Meagan Read, *Michael P Rogers, Paul C Kuo
USF, Tampa, FL
OBJECTIVE(S): Robotic technology is increasingly utilized. To date, there have been few data that suggest improved patient outcomes despite significantly increased charges and costs when comparing robotic procedures to the equivalent laparoscopic reference. As the robot is a classic fixed/indirect cost, we hypothesized that increased volume of robotic procedures over time will result in decreased operative cost per patient. The model of same-day, outpatient, male, primary inguinal hernia (IH) surgery was chosen for simplicity
METHODS: The Florida AHCA database was queried for IH repairs for CY 2015-2020. Inflation adjusted total and operative costs per patient and hospital characteristics were collected. Cost-over-time ($/patient-yr) and change in cost-over-time were calculated for open, lap and robotic cases. Linear regression using cost as the dependent variable generated predictive parameters. Data are presented as mean 土 SD; p<0.05 was considered significant.
RESULTS: Statewide, there were 36393 total cases (19364 open, 12322 lap, 4704 robotic) among 164 hospitals (86 robotic, 78 non-robotic). 18 hospitals were “high volume”, as defined by total hospital robotic IH volume of 100 (range: 107-368) during the study period and had 8604 cases (3915 open, 1786 lap, 2903 robotic). (See Table). In these 18, when compared to lap, total robotic cost and cost over time were 0.22- (p<0.001) and 1.5- fold higher (p<0.002). And, the change in cost-over-time was increasing significantly in robotic cases: 358, 420, 548, 691, and 1542 $/pt-year/year for 2015 to 2020, respectively. Positive contributors to total hospital robotic costs were: total robotic IH volume (17.3), total lap IH volume (12.6), and # hospital beds (1.9). Total open IH volume was a negative contributor (-10).
CONCLUSIONS: We conclude that, in the short term, robotic surgical technology costs are not behaving as traditional fixed costs in outpatient hospital unilateral IH surgeries. Hospital methodology for cost assignment, increase in the robotic contribution to fixed costs such as purchase of more robots and robotic peripherals, and the short time span of this study may explain these results.
|Total Cost ($)||7304**||6001*||4349#|
|Operative Cost ($)||4796**||2922*||2186#|
|Total Cost-Over-Time ($/pt-yr)||358**||241||178#|
|Operative Cost-Over-Time ($/pt-yr)||332**||136*||66#|
|* p<0.05 Lap vs Open;** p<0.05 Lap vs Robotic;|
# p<0.05 Open vs Robotic
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