One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study
Abstract Objective Despite the wide-spread adoption of robotic-assisted surgery (RAS), the cost–benefit implications for partial (PN) and radical nephrectomy (RN) versus laparoscopic surgery (Lap) is not well established. We sought to examine the trend of adoption and 1-year healthcare expenditure o...
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-10111-8 |
| _version_ | 1827635116795494400 |
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| author | Kennedy E. Okhawere Gediwon Milky Shirin Razdan I-Fan Shih Yanli Li Laura Zuluaga Ketan K. Badani |
| author_facet | Kennedy E. Okhawere Gediwon Milky Shirin Razdan I-Fan Shih Yanli Li Laura Zuluaga Ketan K. Badani |
| author_sort | Kennedy E. Okhawere |
| collection | DOAJ |
| description | Abstract Objective Despite the wide-spread adoption of robotic-assisted surgery (RAS), the cost–benefit implications for partial (PN) and radical nephrectomy (RN) versus laparoscopic surgery (Lap) is not well established. We sought to examine the trend of adoption and 1-year healthcare expenditure of PN and RN, and compare 1-year expenditures of RAS versus Lap for PN and RN. Patients and methods This cohort study used the MerativeTM MarketScan® Databases between 2013 and 2020. A total of 5,353 patients with kidney cancer undergoing PN (2,980, 55.7%) or RN (2,373, 44.3%). We compared open-conversion, length of stay (LOS), index expenditure, 1-year healthcare expenditure and utilization, and missed work-days between RAS and Lap for PN and RN. Results Adoption of PN increased overtime (47.0% to 55.8%), mainly driven by robotic PN increase. Among PN, RAS had lower open-conversion, shorter LOS and lower index expenditure than Lap. Among RN, RAS had shorter LOS, and similar open-conversion and index expenditures. During 1-year post-discharge, RAS had lower hospital outpatient visits (IRR = 0.92, 95% CI = 0.85, 0.99, p = 0.029) and office-based visits (IRR = 0.91, 95% CI = 0.86, 0.96, p = 0.002) for PN, translating to a 1-day less (95% CI = 0.25, 1.75, p = 0.008) missed from work for RAS. Following RN, RAS had lower 1-year readmission than Lap (O.R = 0.72, 95% CI = 0.55, 0.94, p = 0.018). RAS and Lap had comparable 1-year post-discharge expenditures for both PN (mean difference, MD = -$475, 95% CI = -$4362, $3412, p = 0.810) and RN (MD = -$4,204, 95% CI = -$13,837, $5430, p = 0.404). Conclusion At index surgery, RAS was associated with shorter LOS for both PN and RN, and lower open-conversion and expenditures for PN. RAS and Lap had comparable 1-year total expenditures, despite lower healthcare visits for RAS. |
| first_indexed | 2024-03-09T15:22:45Z |
| format | Article |
| id | doaj.art-be89abcc53aa4dfab857610504f50f1a |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-09T15:22:45Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-be89abcc53aa4dfab857610504f50f1a2023-11-26T12:43:04ZengBMCBMC Health Services Research1472-69632023-10-0123111010.1186/s12913-023-10111-8One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort studyKennedy E. Okhawere0Gediwon Milky1Shirin Razdan2I-Fan Shih3Yanli Li4Laura Zuluaga5Ketan K. Badani6Department of Urology, Icahn School of Medicine at Mount SinaiIntuitive Surgical, IncDepartment of Urology, Icahn School of Medicine at Mount SinaiIntuitive Surgical, IncIntuitive Surgical, IncDepartment of Urology, Icahn School of Medicine at Mount SinaiDepartment of Urology, Icahn School of Medicine at Mount SinaiAbstract Objective Despite the wide-spread adoption of robotic-assisted surgery (RAS), the cost–benefit implications for partial (PN) and radical nephrectomy (RN) versus laparoscopic surgery (Lap) is not well established. We sought to examine the trend of adoption and 1-year healthcare expenditure of PN and RN, and compare 1-year expenditures of RAS versus Lap for PN and RN. Patients and methods This cohort study used the MerativeTM MarketScan® Databases between 2013 and 2020. A total of 5,353 patients with kidney cancer undergoing PN (2,980, 55.7%) or RN (2,373, 44.3%). We compared open-conversion, length of stay (LOS), index expenditure, 1-year healthcare expenditure and utilization, and missed work-days between RAS and Lap for PN and RN. Results Adoption of PN increased overtime (47.0% to 55.8%), mainly driven by robotic PN increase. Among PN, RAS had lower open-conversion, shorter LOS and lower index expenditure than Lap. Among RN, RAS had shorter LOS, and similar open-conversion and index expenditures. During 1-year post-discharge, RAS had lower hospital outpatient visits (IRR = 0.92, 95% CI = 0.85, 0.99, p = 0.029) and office-based visits (IRR = 0.91, 95% CI = 0.86, 0.96, p = 0.002) for PN, translating to a 1-day less (95% CI = 0.25, 1.75, p = 0.008) missed from work for RAS. Following RN, RAS had lower 1-year readmission than Lap (O.R = 0.72, 95% CI = 0.55, 0.94, p = 0.018). RAS and Lap had comparable 1-year post-discharge expenditures for both PN (mean difference, MD = -$475, 95% CI = -$4362, $3412, p = 0.810) and RN (MD = -$4,204, 95% CI = -$13,837, $5430, p = 0.404). Conclusion At index surgery, RAS was associated with shorter LOS for both PN and RN, and lower open-conversion and expenditures for PN. RAS and Lap had comparable 1-year total expenditures, despite lower healthcare visits for RAS.https://doi.org/10.1186/s12913-023-10111-8Kidney cancerNephrectomyRoboticLaparoscopicExpendituresCosts |
| spellingShingle | Kennedy E. Okhawere Gediwon Milky Shirin Razdan I-Fan Shih Yanli Li Laura Zuluaga Ketan K. Badani One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study BMC Health Services Research Kidney cancer Nephrectomy Robotic Laparoscopic Expenditures Costs |
| title | One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study |
| title_full | One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study |
| title_fullStr | One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study |
| title_full_unstemmed | One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study |
| title_short | One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study |
| title_sort | one year healthcare costs after robotic assisted and laparoscopic partial and radical nephrectomy a cohort study |
| topic | Kidney cancer Nephrectomy Robotic Laparoscopic Expenditures Costs |
| url | https://doi.org/10.1186/s12913-023-10111-8 |
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