Use, Cost, Complications, and Mortality of Robotic versus Nonrobotic General Surgery Procedures Based on a Nationwide Database

2013 ◽  
Vol 79 (6) ◽  
pp. 553-560 ◽  
Author(s):  
Muhammad Salman ◽  
Theodore Bell ◽  
Jennifer Martin ◽  
Kalpesh Bhuva ◽  
Rod Grim ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Length Of Stay ◽  
General Surgery ◽  
New Technology ◽  
Cost Effective ◽  
Robotic Assisted ◽  
Setup Costs ◽  
Lengths Of Stay ◽  
Surgeon Training ◽  
The Cost

Since its introduction in 1997, robotic surgery has overcome many limitations, including setup costs and surgeon training. The use of robotics in general surgery remains unknown. This study evaluates robotic-assisted procedures in general surgery by comparing characteristics with its nonrobotic (laparoscopic and open) counterparts. Weighted Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (2008, 2009) were used to identify the top 12 procedures for robotic general surgery. Robotic cases were identified by Current Procedural Terminology codes 17.41 and 17.42. Procedures were grouped: esophagogastric, colorectal, adrenalectomy, lysis of adhesion, and cholecystectomy. Analyses were descriptive, t tests, χ2s, and logistic regression. Charges and length of stay were adjusted for gender, age, race, payer, hospital bed size, hospital location, hospital region, median household income, Charlson score, and procedure type. There were 1,389,235 (97.4%) nonrobotic and 37,270 (2.6%) robotic cases. Robotic cases increased from 0.8 per cent (2008) to 4.3 per cent (2009, P < 0.001). In all subgroups, robotic surgery had significantly shorter lengths of stay (4.9 days) than open surgery (6.1 days) and lower charges (median $30,540) than laparoscopic ($34,537) and open ($46,704) surgery. Fewer complications were seen in robotic-assisted colorectal, adrenalectomy and lysis of adhesion; however, robotic cholecystectomy and esophagogastric procedures had higher complications than nonrobotic surgery ( P < 0.05). Overall robotic surgery had a lower mortality rate (0.097%) than nonrobotic surgeries per 10,000 procedures (laparoscopic 0.48%, open 0.92%; P < 0.001). The cost of robotic surgery is generally considered a prohibitive factor. In the present study, when overall cost was considered, including length of stay, robotic surgery appeared to be cost-effective and as safe as nonrobotic surgery except in cholecystectomy and esophagogastric procedures. Further study is needed to fully understand the long-term implications of this new technology.

scholarly journals Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

2021 ◽  
Author(s):  
Vivek Sharma ◽  
Thusitha Hettiarachchi ◽  
Dhiraj Sharma ◽  
Irshad Shaikh
Keyword(s):  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Colorectal Surgery ◽  
Anterior Resection ◽  
Cost Effective ◽  
Robotic Assisted ◽  
Novel Method ◽  
Standard Laparoscopic Surgery ◽  
The Cost ◽  
Disposable Equipment

AbstractIn the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

scholarly journals Cost-Effectiveness Analysis Kloramfenikol Dan Seftriakson Untuk Pengobatan Demam Tifoid Pada Pasien Dewasa Di Rumah Sakit Sanglah Denpasar

2019 ◽  
Vol 2 (2) ◽  
pp. 105-112
Author(s):  
Amelia Lorensia ◽  
Doddy De Queljoe ◽  
Made Dwike Swari Santi
Keyword(s):  
Cost Effectiveness ◽  
Length Of Stay ◽  
Typhoid Fever ◽  
Medical Records ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Hospital Perspective ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Two Alternatives

The number of typhoid fever patient in Indonesia is still high. Typhoid fever can be treated by antibiotic therapy such as chloramphenicol and ceftriaxone. The purpose of this study was to compare the cost-effectiveness of chloramphenicol and ceftriaxone which was given to adult patients who were diagnosed with typhoid fever in Sanglah Denpasar Hospital. A comparative study between two alternatives was conducted using the hospital perspective. Retrospective method was used to collect data from patient medical records, who was diagnosed and hospitalized in Sanglah Denpasar Hospital during January 2017 until July 2018. The cost analysis was perform using cost-effectiveness grid and cost-effectiveness ratio (ACER) methods. Cost-effectiveness grid showed that dominant of ceftriaxone for patient with typhoid fever. ACER analysis for ceftriaxone was IDR 2,097,170.88 with effectivenes (length of stay) 4.27 days, and was IDR 2,097,170.88 with effectiveness (the time of reaching normal temperature) 2.42 days. ACER analysis for chloramphenicol was IDR 2,555,464.22        with effectivenes (length of stay) 10.22 days, and was IDR 2,555,464.22 with effectiveness (the time of reaching normal temperature) 3.44 days. ACER analysis showed lower degree of ceftriaxone and higher effectiveness based on length of stay and the time of reaching normal temperature. The conclusion of this study is that ceftriaxone is more cost-effective than chloramphenicol.

scholarly journals IMPLEMENTATION OF GYN ROBOTIC SURGERY IN OUR PRACTICE

2020 ◽  
Vol 62 (2) ◽  
Author(s):  
Antony Brignoni ◽  
◽  
Oksana Mudra ◽  
Keyword(s):  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
High Precision ◽  
Gynecologic Surgery ◽  
Robotic Technology ◽  
High Definition ◽  
Robotic Assisted ◽  
Conventional Laparoscopic

Middle East has launched its first comprehensive robotic surgery programme, Known as one of the most sophisticated laparoscopic surgical technologies available, the device – created by Intuitive – is part of the new programme aimed at enhancing the group’s “current comprehensive general surgery and laparoscopic surgery services”. American Hospital was selected as the hub for this robotic programme as it is already considered a market leader in advanced laparoscopic surgery. According to the manufacturer, the da Vinci Xi HD 4 works by combining conventional laparoscopic techniques with high precision robotic technology that uses four robotic arms controlled by the surgeon from a console. Through the console, the surgeon is also able to access a 3D high-definition view of the surgical area. Robotic surgery is a state of the art surgical procedure in which the conventional laparoscopic technique is combined with high precision robotic technology. Articulated instruments allow the same movement capacity as the human wrist and the tremor filter eliminates any small uncontrollable movement in the surgeon's hands. We would like to share our experience in implementation of Robotic Assisted surgery in gynecological practice of out hospital. Commencement of our program coincided with very difficult period for all World. Regardless COVID pandemic, we started successfully our robo- surgical journey, and within 6 months we performed 150 Robotic assisted surgeries, 50 of them- gynecological. Gynecologic surgery has been transformed in the last three decades in the western world, from mostly open abdominal surgeries with increased length of stay and morbidity to today with minimally invasive surgeries with short length of stay, decreased morbidity, faster return to normal activities and work. Long past the days of doing laparoscopic surgery with direct viewing through a scope, later poor quality imaging monitors to our current High definition 2D and 3D imaging. In the last decade the introduction of Robotics to our surgical armamentarium has steadily increase the likelihood that patients will have minimally invasive procedure instead of an open laparotomy.

scholarly journals Comparative Review on the Cost-Effectiveness Analysis of Relief Teams’ Deployment to Sudden-Onset Disasters

2019 ◽  
Vol 34 (04) ◽  
pp. 415-421 ◽  
Author(s):  
Andrea Bartolucci ◽  
Darren Walter ◽  
Tony Redmond
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Sudden Onset ◽  
Cost Effectiveness Analysis ◽  
Humanitarian Response ◽  
Lengths Of Stay ◽  
Effectiveness Analysis ◽  
Comparative Review ◽  
Detailed Assessment ◽  
The Cost

AbstractWhen a disaster exceeds the capacity of the affected country to cope with its own resources, the provision of external rescue and health services is required, and the deployment of relief units requested. Recently, the cost of international relief and the belief that such deployment is cost-effective has been questioned by the international community; unfortunately, there is still little informed debate and few detailed data are available. This paper presents the results of a comparative review on the cost-effectiveness analysis (CEA) of search and rescue (SAR) and Emergency Medical Team (EMT) deployment. The aim of this work is to provide an overview of the topic, highlight the criteria used to assess the effectiveness, and identify gaps in existing literature. The results show that both deployments are highly expensive, and their success is strongly related to the time they need to be operational; SAR deployments are characterized by limited outcomes in terms of lives saved, and EMTs by insufficient data and lack of detailed assessment. This research highlights that the criteria used to assess the effectiveness need to be explored further, considering different purposes, lengths of stay, and different activities performed, especially for any comparison. This study concludes that data reporting should be mandatory for humanitarian response agencies.

Lengths of Stay and Discharge Dispositions after Total Knee Arthroplasty: A Comparison of Robotic-Assisted and Manual Techniques

2021 ◽  
Author(s):  
Allison Archer ◽  
Hytham S. Salem ◽  
Andrea Coppolecchia ◽  
Michael A. Mont
Keyword(s):  
Length Of Stay ◽  
Large Scale ◽  
Early Discharge ◽  
Robotic Assisted ◽  
Lengths Of Stay ◽  
Home Health Services ◽  
Scale Population ◽  
Manual Group ◽  
Total Knee ◽  
The Mean

AbstractAs evidence signifies that short-stay total knee arthroplasties (TKA) can be safe options, it is important to identify factors that contribute to early discharge. There is evidence that robotic-assisted TKAs may lead to shorter lengths of postoperative stays. However, this has not been evaluated as the primary outcome of interest in a large-scale population. The purpose of this study was to compare manual and robotic-assisted TKAs with regard to: (1) length of stay (LOS) and (2) discharge dispositions. TKAs performed between January 1, 2018, to March 31, 2019, were identified. After applying inclusion and exclusion criteria, a total of 10,296 patients were included: 5,993 in the manual and 4,303 in the robotic-assisted group. Length of stay, discharge dispositions, and Charlson comorbidity indices (CCIs) were recorded for all patients. The mean LOS was significantly lower in robotic-assisted (1.68 ± 0.86 days) compared with manual (1.86 ± 0.94 days) TKA procedures (p < 0.00001). In the robotic-assisted group, 2,049 (47.6%) were discharged in 1 day or less compared with 2,325 (38.8%) in the manual group (p < 0.0001). The proportion discharged home was significantly higher for patients who underwent robotic-assisted (91.3%) compared with manual (87.4%) TKAs (p < 0.00001). When comparing only patients who were discharged home and who did not have home health services, the rate was 51.8% in the robotic-assisted group compared with 44.0% in the manual group (p < 0.00001). The mean CCI was similar for patients who underwent robotic-assisted (2.9 ± 1.4 points) compared with manual (3.0 ± 1.5 points) TKAs. There was a trend toward shorter mean LOS for robotic-assisted versus manual TKA at 17 of the 24 included hospital sites (70.8%). Compared with manual, robotic-assisted TKAs demonstrated shorter lengths of postoperative stays and less need for skilled care after discharge. These results suggest the health care burden resulting from an upsurge of TKA procedures in our aging population might be addressed in part by increased utilization of robotic assistance.

S268 – Cost-Effective Balloon Sinuplasty

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P164-P165
Author(s):  
Paul E Lomeo ◽  
Judith Finneman
Keyword(s):  
Frontal Sinus ◽  
Guide Wire ◽  
New Technology ◽  
Balloon Catheter ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Balloon Sinuplasty ◽  
Guide Catheter ◽  
The Cost

Objectives Balloon sinuplasty is a new procedure that is gaining popularity in the United States. However, with all new technology, there is an increase in cost. Balloon sinuplasty increases the overhead for the facility where it is being performed and does not affect reimbursement. To decrease the cost of new technology, the physician, facility, and the company must all think of creative methods to acheive this goal. Methods In our institution, we had 60 patients that had balloon sinuplasties performed, with all of them involving both maxilary and frontal sinus. Re-useable olive-tip cannula was used instead of the company's recommended disposable guide catheter for the frontal and maxillary sinuses. In using the olive-tip as a guide catheter, the guide wire and balloon catheter are easily directed to the opening of both the maxillary and frontal sinus. Results The outcome from all 60 patients was successful, with none returning for revision. In using the olive-tip cannula instead of the disposable catheter guide for the maxillary and frontal sinuses, there was a savings of $37,500 for the institution. Conclusions The use of an olive-tip cannula from the basic FESS set decreases the cost of performing balloon sinuplasty. This suction-tip can replace the catheter guide without compromising the surgical procedure and is easy to use by the experienced sinus surgeon. There was a cost savings of $625 per procedure when using an olive-tip cannula instead of the company's recommended catheter guide.

Cost-Effectiveness of Conventional vs Robotic-Assisted Laparoscopy in Gynecologic Oncologic Indications

2015 ◽  
Vol 25 (6) ◽  
pp. 1102-1108 ◽  
Author(s):  
Patricia Marino ◽  
Gilles Houvenaeghel ◽  
Fabrice Narducci ◽  
Agnès Boyer-Chammard ◽  
Gwenaël Ferron ◽  
...  
Keyword(s):  
Hospital Costs ◽  
Surgical Techniques ◽  
Cost Effective ◽  
Conventional Laparoscopy ◽  
Fixed Cost ◽  
Operating Theater ◽  
Robotic Assisted ◽  
Number Of Patients ◽  
The Cost ◽  
Robotic Assisted Laparoscopy

ObjectiveRobotic surgical techniques are known to be expensive, but they can decrease the cost of hospitalization and improve patients’ outcomes. The aim of this study was to compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted laparoscopy in the gynecologic oncologic indications.MethodsBetween 2007 and 2010, 312 patients referred for gynecologic oncologic indications (endometrial and cervical cancer), including 226 who underwent conventional laparoscopy and 80 who underwent robot-assisted laparoscopy, were included in this prospective multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting method.ResultsBased on an average number of 165 surgical cases performed per year with the robot, the total extra cost of using the robot was €1456 per intervention. The robot-specific costs amounted to €2213 per intervention, and the cost of the robot-specific surgical supplies was €957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to €1432, which is significantly higher than that of the robotic supplies (P < 0.001). Hospital costs were lower in the case of the robotic strategy (€2380 vs €2841, P < 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (€1490 vs €1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours).ConclusionsThe main driver of additional costs is the fixed cost of the robot, which is not compensated by the lower hospital room costs. The robot would be more cost-effective if robotic interventions were performed on a larger number of patients per year or if the purchase price of the robot was reduced. A shorter learning curve would also no doubt decrease the operating theater costs, resulting in financial benefits to society.

Implications of Changing Dynamics for Metered On-Street Parking

2015 ◽  
Vol 2500 (1) ◽  
pp. 17-25
Author(s):  
Soumya S. Dey ◽  
Stephanie Dock ◽  
Evian Patterson
Keyword(s):  
Real Time ◽  
New Technology ◽  
Cost Effective ◽  
Program Outcomes ◽  
Economic Implications ◽  
Dynamic Congestion Pricing ◽  
The Cost ◽  
Maintenance Personnel ◽  
Real Time Information ◽  
The Impact

The parking industry has seen significant changes over the past decade with the infusion of new technology and smart assets. The introduction of networked meters, virtual payment methods (such as pay-by-cell and credit–debit cards at meters), and technology for real-time detection of space occupancy has resulted in better system uptime, proactive maintenance strategies, multiple payment options, real-time information on parking availability, and better use of spaces through dynamic congestion pricing. The new parking assets and payment options have implications for municipalities and vendors supporting their parking programs. Instead of a significant portion of revenue from coins, virtual transactions account for a predominant share of the parking revenue stream. Focusing on Washington, D.C., as a case study, this paper discusses the economic implications of the changes in the context of overall parking revenue and the cost of different revenue streams for parking. The paper also discusses the impact of these changes on program management (such as maintenance, personnel, and contracting models) and program outcomes (such as customer satisfaction and continued innovation). The paper provides agencies with a framework for taking a holistic look at their parking programs and assessing the impacts of various alternative, cost-effective approaches.

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