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Steffens D, McBride KE, Hirst N, Solomon MJ, Anderson T, Thanigasalam R, Leslie S, Karunaratne S, Bannon PG. Surgical outcomes and cost analysis of a multi-specialty robotic-assisted surgery caseload in the Australian public health system. J Robot Surg 2023; 17:2237-2245. [PMID: 37289337 PMCID: PMC10492768 DOI: 10.1007/s11701-023-01643-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
This study aims to compare surgical outcomes and in-hospital cost between robotic-assisted surgery (RAS), laparoscopic and open approaches for benign gynaecology, colorectal and urological patients and to explore the association between cost and surgical complexity. This retrospective cohort study included consecutive patients undergoing RAS, laparoscopic or open surgery for benign gynaecology, colorectal or urological conditions between July 2018 and June 2021 at a major public hospital in Sydney. Patients' characteristics, surgical outcomes and in-hospital cost variables were extracted from the hospital medical records using routinely collected diagnosis-related groups (DRG) codes. Comparison of the outcomes within each surgical discipline and according to surgical complexity were performed using non-parametric statistics. Of the 1,271 patients included, 756 underwent benign gynaecology (54 robotic, 652 laparoscopic, 50 open), 233 colorectal (49 robotic, 123 laparoscopic, 61 open) and 282 urological surgeries (184 robotic, 12 laparoscopic, 86 open). Patients undergoing minimally invasive surgery (robotic or laparoscopic) presented with a significantly shorter length of hospital stay when compared to open surgical approach (P < 0.001). Rates of postoperative morbidity were significantly lower in robotic colorectal and urological procedures when compared to laparoscopic and open approaches. The total in-hospital cost of robotic benign gynaecology, colorectal and urological surgeries were significantly higher than other surgical approaches, independent of the surgical complexity. RAS resulted in better surgical outcomes, especially when compared to open surgery in patients presenting with benign gynaecology, colorectal and urological diseases. However, the total cost of RAS was higher than laparoscopic and open surgical approaches.
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Affiliation(s)
- Daniel Steffens
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia.
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Hirst
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Teresa Anderson
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sascha Karunaratne
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Paul G Bannon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- The Baird Institute, Sydney, NSW, Australia
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