Cost benefit analysis of robotic vs. Laparoscopic hepatectomy: A propensity matched retrospective cohort study of acs nsqip database

Abstract

Presenter: Henry Miller MD | Cooper University Hospital Background: Utilization of robotic and laparoscopic hepatectomies are becoming more prevalent as minimally invasive approaches to hepatobiliary are expanding. As the current data on outcomes from such approaches are emerging, the cost-benefit analysis associated with these innovative strategies is sparse. This study aims to compare the costs associated with robotic versus laparoscopic liver resections, taking into account 30-day complications using a national database. Methods: Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014-2017 was identified. The cost was assigned to peri-operative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from Centers for Medicare & Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data (Cooper University Hospital, 2018-2019). Results: In our matched cohort of 454 patients (227 per group), total costs associated with laparoscopic liver resections were estimated at $5.5M ($24K per patient) vs. $6.8M ($29.8K per patient) for robotic liver resections (21.3% difference)(p < 0.001). The higher cost associated with robotic hepatectomies were related to costs for blood transfusions ($22.0K vs. $12.1K)(p=0.02), length of stay ($2.05M vs. $1.76M)(p=0.046), and operating room time ($4.01M vs $3.24M) (p<0.0001). 30-day mortality rates were similar between the two groups, with two mortalities in the robotic group, and zero in the laparoscopic group (p=0.499). Conclusion: Robotic hepatectomies have a higher cost associated compared to laparoscopic hepatectomies, mainly due to the increased OR time and more extended hospital stay. There was no difference in overall 30-day mortality for these two approaches. Given the current concerns with the rising cost of healthcare, the benefits of robotic liver resections must be carefully weighed against the greater cost of this approach.