Education / Lap & Robotics / Surgical Innovations
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective : In well-selected patients the use of minimally invasive techniques has been shown not to compromise outcomes or complication rates. The question remains whether the additional cost of the equipment is warranted. Using a large national data set, we sought to perform a cost comparison between open, laparoscopic, and robotic radical nephrectomy (RN) and partial nephrectomy (PN) and examine variables that drive cost.
Methods : The National Inpatient Sample was queried from January 2001 to December 2013 for the following ICD-9 codes: 55.5 complete nephrectomy, 55.54 bilateral nephrectomy, and 55.4 partial nephrectomy. The ICD-9 code 17.42, available from 2008 onward, was used to identify robotic-assisted laparoscopic cases; 54.21 and 54.51 were used to identify laparoscopic cases. The primary outcome was total cost. Length of stay (LOS) was examined as a secondary outcome. Univariate analyses were performed with ANOVA tests for continuous variables and chi square tests for binary and categorical variables. A multivariate analysis was performed using generalized linear models for continuous outcome measures (total cost and LOS). Cost each year was adjusted for inflation to bring all values to the equivalent of US dollars in 2015. All statistical analyses were performed using STATA, version 12.1.
Results : The mean cost for PN open was $16,457, laparoscopic $16,486, and robotic $17,092 (p=0.002). The mean LOS for PN open was 4.7 days, laparoscopic 3.5 days, and robotic 2.9 days (p <0.001). The mean cost for RN open was $19,273, laparoscopic $16,650, and robotic $19,491 (p<0.001). The mean LOS for a RN open was 5.7 days, laparoscopic 4.0 days, and robotic 3.7 days (p<0.001). Variables found to significantly increase cost for both RN and PN include minority race, noncommercial insurance, increased severity of illness, transfer from another facility or admission through the emergency department, emergency status, and location in the west. For PN both the use of laparoscopy and robotics increased cost significantly, whereas for RN only the use of robotics increased cost significantly.
Conclusions : While minimally invasive approaches have become increasingly popular, this study demonstrates there is additional cost associated with them despite reduced length of stay for partial nephrectomy. Conversely, laparoscopic radical nephrectomy seems to offer both reduced cost and length of stay.