Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA.
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA.
J Robot Surg. 2024 Feb 3;18(1):63. doi: 10.1007/s11701-023-01809-2.
The surgical robot is assumed to be a fixed, indirect cost. We hypothesized rising volume of robotic bariatric procedures would decrease cost per patient over time. Patients who underwent elective, initial gastric bypass (GB) or sleeve gastrectomy (SG) for morbid obesity were selected from Florida Agency for Health Care Administration database from 2017 to 2021. Inflation-adjusted cost per patient was collected. Cost-over-time ($/patient year) and change in cost-over-time were calculated for open, laparoscopic, and robotic cases. Linear regression on cost generated predictive parameters. Density plots utilizing area under the curve demonstrated cost overlap. Among 76 hospitals, 11,472 bypasses (223 open, 6885 laparoscopic, 4364 robotic) and 36,316 sleeves (26,596 laparoscopic, 9724 robotic) were included. Total cost for robotic was approximately 1.5-fold higher (p < 0.001) than laparoscopic for both procedures. For GB, laparoscopic had lower total ($15,520) and operative ($6497) average cost compared to open (total $17,779; operative $9273) and robotic (total $21,756; operative $10,896). For SG, laparoscopic total cost was significantly less than robotic ($10,691 vs. $16,393). Robotic GB cost-over-time increased until 2021, when there was a large decrease in cost (-$944, compared with 2020). Robotic SG total cost-over time fluctuated, but decreased significantly in 2021 (-$490 compared with 2020). While surgical costs rose significantly in 2020 for bariatric procedures, our study suggests a possible downward trend in robotic bariatric surgery as total and operative costs are decreasing at a higher rate than laparoscopic costs.
手术机器人被视为一种固定的间接成本。我们假设随着机器人减重手术数量的增加，每位患者的成本将随着时间的推移而降低。从 2017 年到 2021 年，从佛罗里达州卫生保健管理局数据库中选择了因病态肥胖而接受择期初始胃旁路术（GB）或袖状胃切除术（SG）的患者。收集了每位患者的通胀调整后成本。计算了开放、腹腔镜和机器人手术的患者年度成本（$/患者年）和年度成本变化。对成本进行线性回归以生成预测参数。利用曲线下面积的密度图显示了成本重叠。在 76 家医院中，共纳入 11472 例旁路术（223 例开放，6885 例腹腔镜，4364 例机器人）和 36316 例袖状胃切除术（26596 例腹腔镜，9724 例机器人）。对于两种手术，机器人的总费用（p<0.001）大约是腹腔镜的 1.5 倍。对于 GB，腹腔镜手术的总费用（$15520）和手术费用（$6497）低于开放手术（总费用$17779；手术费用$9273）和机器人手术（总费用$21756；手术费用$10896）。对于 SG，腹腔镜手术的总费用明显低于机器人手术（$10691 比$16393）。GB 机器人手术的年度成本一直在增加，直到 2021 年成本大幅下降（与 2020 年相比下降了$944）。SG 机器人手术的年度总费用波动，但在 2021 年显著下降（与 2020 年相比下降了$490）。虽然 2020 年减重手术的手术费用显著增加，但我们的研究表明，机器人减重手术可能呈下降趋势，因为总手术费用和手术费用的下降速度高于腹腔镜手术费用。
