Robotic distal pancreatectomy: Cost effective?
Background Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic di...
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| Veröffentlicht in: | Surgery 2010-10, Vol.148 (4), p.814-823 |
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| creator | Waters, Joshua A., MD Canal, David F., MD Wiebke, Eric A., MD Dumas, Ryan P., BS Beane, Joal D., BA Aguilar-Saavedra, Juan R., MD Ball, Chad G., MD House, Michael G., MD Zyromski, Nicholas J., MD Nakeeb, Attila, MD Pitt, Henry A., MD Lillemoe, Keith D., MD Schmidt, C. Max, MD, PhD, MBA |
| description | Background Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic distal pancreatectomies. We hypothesized that robotic distal pancreatectomy is cost-effective. Methods Between August 2008 and August 2009, 77 distal pancreatectomies were performed at a single academic medical center. A retrospective analysis of prospectively collected data on demographics, short-term outcomes, and direct cost was performed. Results Thirty-two open distal pancreatectomies, 28 laparoscopic distal pancreatectomies, and 17 robotic distal pancreatectomies were performed. Age, American Society of Anesthesia preoperative risk score, and specimen length were similar. Indications for laparoscopic distal pancreatectomies and robotic distal pancreatectomies included more cystic neoplasms (49%) and fewer malignancies (29%) versus open distal pancreatectomies (16% and 47%). Spleen preservation occurred in 65% robotic distal pancreatectomies versus 12% and 29% in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The operative time averaged 298 minutes in robotic distal pancreatectomies versus 245 and 222 minutes in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). Blood loss and morbidity were similar with no mortality. The length of stay was 4 days in robotic distal pancreatectomies versus 8 and 6 in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The total cost was $10,588 in robotic distal pancreatectomies versus $16,059 and $12,986 in open distal pancreatectomies and laparoscopic distal pancreatectomies. Conclusion These data suggest direct hospital costs are comparable among all groups. They suggest a shorter length of stay in robotic versus laparoscopic or open approaches. Finally, spleen and vessel preservation rates may improve with a robotic approach at the expense of increased operative time. In summary, robotic distal pancreatectomy is safe and cost effective in selected cases. |
| doi_str_mv | 10.1016/j.surg.2010.07.027 |
| format | Article |
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Max, MD, PhD, MBA</creator><creatorcontrib>Waters, Joshua A., MD ; Canal, David F., MD ; Wiebke, Eric A., MD ; Dumas, Ryan P., BS ; Beane, Joal D., BA ; Aguilar-Saavedra, Juan R., MD ; Ball, Chad G., MD ; House, Michael G., MD ; Zyromski, Nicholas J., MD ; Nakeeb, Attila, MD ; Pitt, Henry A., MD ; Lillemoe, Keith D., MD ; Schmidt, C. Max, MD, PhD, MBA</creatorcontrib><description>Background Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic distal pancreatectomies. We hypothesized that robotic distal pancreatectomy is cost-effective. Methods Between August 2008 and August 2009, 77 distal pancreatectomies were performed at a single academic medical center. A retrospective analysis of prospectively collected data on demographics, short-term outcomes, and direct cost was performed. Results Thirty-two open distal pancreatectomies, 28 laparoscopic distal pancreatectomies, and 17 robotic distal pancreatectomies were performed. Age, American Society of Anesthesia preoperative risk score, and specimen length were similar. Indications for laparoscopic distal pancreatectomies and robotic distal pancreatectomies included more cystic neoplasms (49%) and fewer malignancies (29%) versus open distal pancreatectomies (16% and 47%). Spleen preservation occurred in 65% robotic distal pancreatectomies versus 12% and 29% in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The operative time averaged 298 minutes in robotic distal pancreatectomies versus 245 and 222 minutes in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). Blood loss and morbidity were similar with no mortality. The length of stay was 4 days in robotic distal pancreatectomies versus 8 and 6 in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The total cost was $10,588 in robotic distal pancreatectomies versus $16,059 and $12,986 in open distal pancreatectomies and laparoscopic distal pancreatectomies. Conclusion These data suggest direct hospital costs are comparable among all groups. They suggest a shorter length of stay in robotic versus laparoscopic or open approaches. Finally, spleen and vessel preservation rates may improve with a robotic approach at the expense of increased operative time. In summary, robotic distal pancreatectomy is safe and cost effective in selected cases.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2010.07.027</identifier><identifier>PMID: 20797748</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Cost-Benefit Analysis ; Female ; Humans ; Laparoscopy - economics ; Male ; Middle Aged ; Pancreatectomy - economics ; Pancreatectomy - methods ; Pancreatic Neoplasms - surgery ; Robotics - economics ; Surgery</subject><ispartof>Surgery, 2010-10, Vol.148 (4), p.814-823</ispartof><rights>Mosby, Inc.</rights><rights>2010 Mosby, Inc.</rights><rights>Copyright © 2010 Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-3d51fd1cf5fa3c912d2ecc942865b1d3ded30169b6ce3d1594698de1f96abcc43</citedby><cites>FETCH-LOGICAL-c410t-3d51fd1cf5fa3c912d2ecc942865b1d3ded30169b6ce3d1594698de1f96abcc43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0039606010003958$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20797748$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Waters, Joshua A., MD</creatorcontrib><creatorcontrib>Canal, David F., MD</creatorcontrib><creatorcontrib>Wiebke, Eric A., MD</creatorcontrib><creatorcontrib>Dumas, Ryan P., BS</creatorcontrib><creatorcontrib>Beane, Joal D., BA</creatorcontrib><creatorcontrib>Aguilar-Saavedra, Juan R., MD</creatorcontrib><creatorcontrib>Ball, Chad G., MD</creatorcontrib><creatorcontrib>House, Michael G., MD</creatorcontrib><creatorcontrib>Zyromski, Nicholas J., MD</creatorcontrib><creatorcontrib>Nakeeb, Attila, MD</creatorcontrib><creatorcontrib>Pitt, Henry A., MD</creatorcontrib><creatorcontrib>Lillemoe, Keith D., MD</creatorcontrib><creatorcontrib>Schmidt, C. Max, MD, PhD, MBA</creatorcontrib><title>Robotic distal pancreatectomy: Cost effective?</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic distal pancreatectomies. We hypothesized that robotic distal pancreatectomy is cost-effective. Methods Between August 2008 and August 2009, 77 distal pancreatectomies were performed at a single academic medical center. A retrospective analysis of prospectively collected data on demographics, short-term outcomes, and direct cost was performed. Results Thirty-two open distal pancreatectomies, 28 laparoscopic distal pancreatectomies, and 17 robotic distal pancreatectomies were performed. Age, American Society of Anesthesia preoperative risk score, and specimen length were similar. Indications for laparoscopic distal pancreatectomies and robotic distal pancreatectomies included more cystic neoplasms (49%) and fewer malignancies (29%) versus open distal pancreatectomies (16% and 47%). Spleen preservation occurred in 65% robotic distal pancreatectomies versus 12% and 29% in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The operative time averaged 298 minutes in robotic distal pancreatectomies versus 245 and 222 minutes in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). Blood loss and morbidity were similar with no mortality. The length of stay was 4 days in robotic distal pancreatectomies versus 8 and 6 in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The total cost was $10,588 in robotic distal pancreatectomies versus $16,059 and $12,986 in open distal pancreatectomies and laparoscopic distal pancreatectomies. Conclusion These data suggest direct hospital costs are comparable among all groups. They suggest a shorter length of stay in robotic versus laparoscopic or open approaches. Finally, spleen and vessel preservation rates may improve with a robotic approach at the expense of increased operative time. In summary, robotic distal pancreatectomy is safe and cost effective in selected cases.</description><subject>Cost-Benefit Analysis</subject><subject>Female</subject><subject>Humans</subject><subject>Laparoscopy - economics</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatectomy - economics</subject><subject>Pancreatectomy - methods</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Robotics - economics</subject><subject>Surgery</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAQxUVoabZJv0AOZW892R1Jlm2F0hCWtikEAkl7FvJoXLTxWlvJDuy3r8ymPfSQ0_zhvQfzG8YuOJQceP1xW6Y5_ioF5AU0JYjmhK24kqJoZM1fsRWA1EUNNZyytyltAUBXvH3DTgU0ummqdsXK-9CFyePa-TTZYb23I0ayE-EUdofL9SakaU19n2f_RFfn7HVvh0TvnusZ-_n1y4_NTXF79-375vq2wIrDVEineO849qq3EjUXThCirkRbq4476cjJfIHuaiTpuNJVrVtHvNe17RArecY-HHP3MfyeKU1m5xPSMNiRwpxMoxTXUFUqK8VRiTGkFKk3--h3Nh4MB7NgMluzYDILJgONyZiy6f1z_NztyP2z_OWSBZ-OAspHPnmKJqGnEcn5mFEYF_zL-Z__s-PgR492eKQDpW2Y45jxGW6SMGAelkctf-KwdKqVfwDEmI2G</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Waters, Joshua A., MD</creator><creator>Canal, David F., MD</creator><creator>Wiebke, Eric A., MD</creator><creator>Dumas, Ryan P., BS</creator><creator>Beane, Joal D., BA</creator><creator>Aguilar-Saavedra, Juan R., MD</creator><creator>Ball, Chad G., MD</creator><creator>House, Michael G., MD</creator><creator>Zyromski, Nicholas J., MD</creator><creator>Nakeeb, Attila, MD</creator><creator>Pitt, Henry A., MD</creator><creator>Lillemoe, Keith D., MD</creator><creator>Schmidt, C. Max, MD, PhD, MBA</creator><general>Mosby, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>Robotic distal pancreatectomy: Cost effective?</title><author>Waters, Joshua A., MD ; Canal, David F., MD ; Wiebke, Eric A., MD ; Dumas, Ryan P., BS ; Beane, Joal D., BA ; Aguilar-Saavedra, Juan R., MD ; Ball, Chad G., MD ; House, Michael G., MD ; Zyromski, Nicholas J., MD ; Nakeeb, Attila, MD ; Pitt, Henry A., MD ; Lillemoe, Keith D., MD ; Schmidt, C. Max, MD, PhD, MBA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-3d51fd1cf5fa3c912d2ecc942865b1d3ded30169b6ce3d1594698de1f96abcc43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Cost-Benefit Analysis</topic><topic>Female</topic><topic>Humans</topic><topic>Laparoscopy - economics</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreatectomy - economics</topic><topic>Pancreatectomy - methods</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Robotics - economics</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Waters, Joshua A., MD</creatorcontrib><creatorcontrib>Canal, David F., MD</creatorcontrib><creatorcontrib>Wiebke, Eric A., MD</creatorcontrib><creatorcontrib>Dumas, Ryan P., BS</creatorcontrib><creatorcontrib>Beane, Joal D., BA</creatorcontrib><creatorcontrib>Aguilar-Saavedra, Juan R., MD</creatorcontrib><creatorcontrib>Ball, Chad G., MD</creatorcontrib><creatorcontrib>House, Michael G., MD</creatorcontrib><creatorcontrib>Zyromski, Nicholas J., MD</creatorcontrib><creatorcontrib>Nakeeb, Attila, MD</creatorcontrib><creatorcontrib>Pitt, Henry A., MD</creatorcontrib><creatorcontrib>Lillemoe, Keith D., MD</creatorcontrib><creatorcontrib>Schmidt, C. Max, MD, PhD, MBA</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Waters, Joshua A., MD</au><au>Canal, David F., MD</au><au>Wiebke, Eric A., MD</au><au>Dumas, Ryan P., BS</au><au>Beane, Joal D., BA</au><au>Aguilar-Saavedra, Juan R., MD</au><au>Ball, Chad G., MD</au><au>House, Michael G., MD</au><au>Zyromski, Nicholas J., MD</au><au>Nakeeb, Attila, MD</au><au>Pitt, Henry A., MD</au><au>Lillemoe, Keith D., MD</au><au>Schmidt, C. Max, MD, PhD, MBA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robotic distal pancreatectomy: Cost effective?</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>148</volume><issue>4</issue><spage>814</spage><epage>823</epage><pages>814-823</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Minimally invasive techniques and even robotics in pancreaticobiliary surgery are being used increasingly. Cost-effectiveness is a practical burden associated with the introduction of surgical innovation. This study compares the costs and the outcomes of open, laparoscopic, and robotic distal pancreatectomies. We hypothesized that robotic distal pancreatectomy is cost-effective. Methods Between August 2008 and August 2009, 77 distal pancreatectomies were performed at a single academic medical center. A retrospective analysis of prospectively collected data on demographics, short-term outcomes, and direct cost was performed. Results Thirty-two open distal pancreatectomies, 28 laparoscopic distal pancreatectomies, and 17 robotic distal pancreatectomies were performed. Age, American Society of Anesthesia preoperative risk score, and specimen length were similar. Indications for laparoscopic distal pancreatectomies and robotic distal pancreatectomies included more cystic neoplasms (49%) and fewer malignancies (29%) versus open distal pancreatectomies (16% and 47%). Spleen preservation occurred in 65% robotic distal pancreatectomies versus 12% and 29% in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The operative time averaged 298 minutes in robotic distal pancreatectomies versus 245 and 222 minutes in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). Blood loss and morbidity were similar with no mortality. The length of stay was 4 days in robotic distal pancreatectomies versus 8 and 6 in open distal pancreatectomies and laparoscopic distal pancreatectomies ( P < .05). The total cost was $10,588 in robotic distal pancreatectomies versus $16,059 and $12,986 in open distal pancreatectomies and laparoscopic distal pancreatectomies. Conclusion These data suggest direct hospital costs are comparable among all groups. They suggest a shorter length of stay in robotic versus laparoscopic or open approaches. Finally, spleen and vessel preservation rates may improve with a robotic approach at the expense of increased operative time. In summary, robotic distal pancreatectomy is safe and cost effective in selected cases.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>20797748</pmid><doi>10.1016/j.surg.2010.07.027</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Cost-Benefit Analysis Female Humans Laparoscopy - economics Male Middle Aged Pancreatectomy - economics Pancreatectomy - methods Pancreatic Neoplasms - surgery Robotics - economics Surgery |
| title | Robotic distal pancreatectomy: Cost effective? |
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