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. 2023 Feb;17(1):49-54.
doi: 10.1007/s11701-022-01385-x. Epub 2022 Mar 19.

Direct medical costs of robotic sleeve gastrectomy compared to laparoscopic approach in a single academic center

Jean F Salem  1 , Wayne B Bauerle  1 , Abdulaziz A Arishi  1 , Jill Stoltzfus  1   2 , Maher El Chaar  3   4   5
Affiliations

Direct medical costs of robotic sleeve gastrectomy compared to laparoscopic approach in a single academic center

Jean F Salem et al. J Robot Surg. 2023 Feb.

Abstract

Background: The use of the robotic platform in bariatric surgery remains controversial because of lack of level I evidence to support its superiority compared to the laparoscopic approach and because of cost concerns. Recently, an extended use program (EUP) for robotic instruments was also introduced at our institution to help reduce the associated direct medical costs of robotic surgery.

Objectives: To evaluate the direct medical costs of a robotic sleeve gastrectomy (R-SG) and compare it to a standard laparoscopic approach (L-SG).

Setting: Academic, tertiary care center.

Methods: The analysis included the last 50 R-SG performed at our institution between June 1st 2019 and October 31st 2020. Those cases were compared to the L-SG cases (29 cases) performed in the same time period. All revisions or conversions were then excluded which resulted in a total of 74 primary SG (R-SG = 45 and L-SG = 29). Direct medical costs included operating room cost, instrument cost, miscellaneous cost, and cost of hospital stay. Direct cost data was generated using the StrataJazz reporting module, which is fed daily from EPIC, our electronic health record system. Patients who underwent a primary SG or a primary SG with a concomitant Paraesophageal Hernia Repair (PEH) were analyzed separately using Mann-Whitney rank sum tests and Student's t tests. An additional analysis and subanalysis of the groups was also performed after applying the potential savings of the Extended Use Program (EUP).

Results: Overall, the direct medical cost of R-SG was comparable to L-SG ($6330.77 vs $6804.12 respectively, p = 0.07). The direct medical cost of patients undergoing SG alone without PEH was significantly lower in the R-group compared to the L-group ($5927.08 vs $6508.01, respectively, p = 0.04). When applying the EUP savings to our data, the predicted direct medical cost of R-SG becomes significantly lower than L-SG ($6145.77 vs $6804.12 respectively, p = 0.01).

Conclusion: At our academic medical center, we found no difference in direct medical costs between R-SG and L-SG. With the application of the EUP, direct medical costs of R-SG can be significantly lowered compared to L-SG. It is important to consider that cost data are largely dependent upon the academic medical center of interest, and surgeons need to collect their own cost data to evaluate whether robotic surgery is feasible at their institution.

Keywords: Bariatric surgery; Cost; Laparoscopic surgery; Robotic surgery; Sleeve gastrectomy.

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References

    1. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C et al (2019) Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med 381(25):2440–2450 - DOI - PubMed
    1. Reges O, Greenland P, Dicker D, Leibowitz M, Hoshen M, Gofer I et al (2018) Association of bariatric surgery using laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy vs usual care obesity management with all-cause mortality. JAMA 319(3):279–290 - DOI - PubMed - PMC
    1. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA et al (2017) Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med 376(7):641–651 - DOI - PubMed - PMC
    1. English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA et al (2020) American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis 16(4):457–463 - DOI - PubMed
    1. Tatarian T, Yang J, Wang J, Docimo S, Talamini M, Pryor AD et al (2021) Trends in the utilization and perioperative outcomes of primary robotic bariatric surgery from 2015 to 2018: a study of 46,764 patients from the MBSAQIP data registry. Surg Endosc 35(7):3915–3922 - DOI - PubMed

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