M. Eby1, J. Parreco1, R. Martinez1, R. Kozol1 1University Of Miami,General Surgery,Miami, FL, USA
Introduction:
Previous studies have shown the benefits of thoracoscopic procedures in regards to less postoperative pain, faster recovery, and less overall cost when compared to open surgery. However, the comparison of thoracoscopic alone versus robotic assisted thoracoscopic procedures is less well known. The purpose of this study was to compare overall outcomes and costs associated with thoracoscopic alone versus robotic assisted thoracoscopic procedures.
Methods:
The Nationwide Readmission Database (NRD) was queried for all patients with admissions with elective thoracoscopic and robotic assisted thoracoscopic procedures in 2013. The most common diagnoses with total costs were calculated. Multivariate logistic regression was then implemented using patient comorbidities and demographics as well as hospital characteristics to determine the odds ratios (OR) of outcomes.
Results:
During the study period, 24,707 patients underwent thoracoscopic procedures with 2,837 (11.5%) being robotic assisted and 21,870 (88.5%) thoracoscopic alone. The mean robotic assisted total admission cost was $25,409.16 SD+/-21,523.75 while the mean total thoracoscopic alone was $19,470.92 SD+/-20,380.66 (p<0.01, 95% CI 5,133.20 to 6,743.29). The mean cost of readmissions for robotic assisted was $23,467.70 SD+/-32,578.80 while the mean cost of readmissions for thoracoscopic alone was $23,759.56 SD+/-35,416.83 (p=0.85, 95% CI -3,312.41 to 2,728.70). The most common primary diagnosis for patients undergoing robotic assisted thoracoscopic procedures was malignant neoplasm of upper lobe, bronchus or lung at 777 patients (27.4%) with a mean total admission cost of $27,160.17 (+/-20,299.65). This was also the most common primary diagnosis for patients undergoing thoracoscopic alone procedures with 4,932 patients (22.6%) and a mean total admission cost of $22,382.38 (+/-17,882.993). The OR for mortality in thoracoscopic alone patients was 1.28 (p=0.08, 95% CI 0.97 to 1.68) and the OR for readmission was 1.12 (p=0.03, 95% CI 1.01 to 1.24).
Conclusion:
Initial admission costs are higher in patients undergoing robotic assisted thoracoscopic procedures compared to thoracoscopic alone. However, readmission costs are similar and readmissions occur at a higher rate in patients undergoing thoracoscopic alone procedures. Therefore, with lower readmission rates and equivalent overall survival, robotic assisted thoracoscopic procedures prove to be beneficial and potentially superior in both patient outcomes and reduction in net health care costs when compared to thoracoscopic alone.