Faculty Opinions recommendation of Modifiable factors to decrease the cost of robotic-assisted procedures.

Objective This study employed the “three-delay” model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan. Study Design A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected. Results During the study period (August 1, 2019–February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths. Conclusion The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors. Key Points

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The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample

Surgical Endoscopy ◽

10.1007/s00464-018-6507-3 ◽

2018 ◽

Vol 33 (7) ◽

pp. 2217-2221 ◽

Cited By ~ 17

Author(s):

Zhamak Khorgami ◽

Wei T. Li ◽

Theresa N. Jackson ◽

C. Anthony Howard ◽

Guido M. Sclabas

Keyword(s):

Laparoscopic Surgery ◽

National Inpatient Sample ◽

Robotic Assisted ◽

The Cost

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

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000458 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1102-1108 ◽

Cited By ~ 24

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.

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Comparative Cost Analysis of Robotic-Assisted and Jig-Based Manual Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1713895 ◽

2020 ◽

Cited By ~ 3

Author(s):

Eric J. Cotter ◽

Jesse Wang ◽

Richard L. Illgen

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Cost Savings ◽

Patient Characteristics ◽

Robotic Assisted ◽

Episode Of Care ◽

Total Knee ◽

Implant System ◽

The Cost

AbstractExcellent durability with traditional jig-based manual total knee arthroplasty (mTKA) has been noted, but substantial rates of dissatisfaction remain. Robotic-assisted TKA (raTKA) was introduced to improve clinical outcomes, but associated costs have not been well studied. The purpose of our study is to compare 90-day episode-of-care (EOC) costs for mTKA and raTKA. A retrospective review of an institutional database from 4/2015 to 9/2017 identified consecutive mTKAs and raTKAs using a single implant system performed by one surgeon. The raTKA platform became available at our institution in October 2016. Prior to this date, all TKAs were performed with mTKA technique. After this date, all TKAs were performed using robotic-assistance without exception. Sequential cases were included for both mTKA and raTKA with no patients excluded. Clinical and financial data were obtained from medical and billing records. Ninety-day EOC costs were compared. Statistical analysis was performed by departmental statistician. One hundred and thirty nine mTKAs and 147 raTKAs were identified. No significant differences in patient characteristics were noted. Total intraoperative costs were higher ($10,295.17 vs. 9,998.78, respectively, p < 0.001) and inpatient costs were lower ($3,893.90 vs. 5,587.40, respectively, p < 0.001) comparing raTKA and mTKA. Length of stay (LOS) was reduced 25% (1.2 vs. 1.6 days, respectively, p < 0.0001) and prescribed opioids were reduced 57% (984.2 versus 2240.4 morphine milligram equivalents, respectively, p < 0.0001) comparing raTKA with mTKA. Ninety-day EOC costs were $2,090.70 lower for raTKA compared with mTKA ($15,629.94 vs. 17,720.64, respectively; p < 0.001). The higher intraoperative costs associated with raTKA were offset by greater savings in postoperative costs for the 90-day EOC compared with mTKA. Higher intraoperative costs were driven by the cost of the robot, maintenance fees, and robot-specific disposables. Cost savings with raTKA were primarily driven by reduced instrument pan reprocessing fees, shorter LOS, and reduced prescribed opioids compared with mTKA technique. raTKA demonstrated improved value compared with mTKA based on significantly lower average 90-day EOC costs and superior quality exemplified by reduced LOS, less postoperative opioid requirements, and reduced postdischarge resource utilization.

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

Indian Journal of Surgery ◽

10.1007/s12262-021-02864-5 ◽

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.

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Drivers of Variability in 90-Day Cost for Elective Laminectomy and Fusion for Lumbar Degenerative Disease

Neurosurgery ◽

10.1093/neuros/nyy264 ◽

2018 ◽

Vol 84 (5) ◽

pp. 1043-1049 ◽

Cited By ~ 6

Author(s):

Ahilan Sivaganesan ◽

Silky Chotai ◽

Scott L Parker ◽

Matthew J McGirt ◽

Clinton J Devin

Keyword(s):

Regression Tree ◽

Length Of Hospital Stay ◽

Opioid Use ◽

Tree Model ◽

Lumbar Degenerative Disease ◽

Modifiable Factors ◽

Duration Of Surgery ◽

Laminectomy And Fusion ◽

The Cost ◽

Prospective Longitudinal

Abstract BACKGROUND Considerable variability exists in the cost of surgery following spine surgery for common degenerative spine diseases. This variation in the cost of surgery can affect the payment bundling during the postoperative 90 d. OBJECTIVE To determine the drivers of variability in total 90-d cost for laminectomy and fusion surgery. METHODS A total of 752 patients who underwent elective laminectomy and fusion for degenerative lumbar conditions and were enrolled into a prospective longitudinal registry were included in the study. Total cost during the 90-d global period was derived as sum of cost of surgery, cost associated with postdischarge utilization. Multivariable regression models were built for total 90-d cost. RESULTS The mean 90-d direct cost was $29 295 (range, $28 612-$29 973). Based on our regression tree analysis, the following variables were found to drive the 90-d cost: age, BMI, gender, diagnosis, postop imaging, number of operated levels, ASA grade, hypertension, arthritis, preop and postop opioid use, length of hospital stay, duration of surgery, 90-d readmission, outpatient physical/occupational therapy, inpatient rehab, postop healthcare visits, postop nonopioid pain medication use nonsteroidal antiinflammatory drug (NSAIDs), and muscle relaxant use. The R2 for tree model was 0.64. CONCLUSION Utilizing prospectively collected data, we demonstrate that considerable variation exists in total 90-d cost, nearly 70% of which can be explained by those factors included in our modeling. Risk-adjusted payment schemes can be crafted utilizing the significant drivers presented here. Focused interventions to target some of the modifiable factors have potential to reduce cost and increase the value of care.

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Evaluation of Operative Waste in a Military Medical Center: Analysis of Operating Room Cost and Waste during Surgical Cases

The American Surgeon ◽

10.1177/000313481908500729 ◽

2019 ◽

Vol 85 (7) ◽

pp. 717-720 ◽

Cited By ~ 1

Author(s):

Elizabeth D. Rose ◽

David M. Modlin ◽

Maeghan L. Ciampa ◽

Christopher W. Mangieri ◽

Byron J. Faler ◽

...

Keyword(s):

Quality Improvement ◽

Inguinal Hernia ◽

Observational Study ◽

Medical Center ◽

Hospital Costs ◽

Improvement Project ◽

Robotic Assisted ◽

Surgical Devices ◽

The Cost ◽

Complex Cases

Operating rooms (ORs) contribute to at least 40 per cent of hospital costs. There is an existing cost waste in ORs for surgical devices that are opened without being used. There is a paucity of data evaluating the hospital cost of opened but unused OR supplies. The goal of this observational study is to examine the cost of opened but unused OR supplies for general surgery cases. We performed a quality improvement project of OR cost waste by observing 30 cases. Surgical cases of a senior surgeon who had been at the institution for more than five years were evaluated for items opened appropriately and whether the items are used. The cases evaluated ranged from open hernia repairs to robotic-assisted hernia repairs. We found that the cost of instruments opened but not used was $4528.18. Of the cases evaluated, we found that a range of 0 per cent to 27 per cent of total items were wasted, an average of 8.3 per cent. We found that for the open inguinal hernia case, there was minimal waste. The highest waste was among complex cases such as the robotic-assisted inguinal hernia with an average waste and cost of 15.8 per cent and $379. We found that on average for less complex cases such as open inguinal hernia repairs, $1.44 was potentially wasted per case, whereas for more complex cases up to $379 was wasted per case. We identified the outdated preference cards, lack of instrument knowledge, circulating nurse, and surgical technician distractions as reasons for contributing to waste.

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The Cost of Learning Robotic-Assisted Prostatectomy

Urology ◽

10.1016/j.urology.2007.11.118 ◽

2008 ◽

Vol 72 (5) ◽

pp. 1068-1072 ◽

Cited By ~ 76

Author(s):

Peter L. Steinberg ◽

Paul A. Merguerian ◽

William Bihrle ◽

John D. Seigne

Keyword(s):

Robotic Assisted ◽

The Cost

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P105 Robosurgeons vs. robosceptics’: can we afford robotic technology or can we afford not to?

BJS Open ◽

10.1093/bjsopen/zrab032.104 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Jasmesh Sandhu ◽

Jasmesh Sandhu

Keyword(s):

Cost Effectiveness ◽

Radical Prostatectomy ◽

High Volume ◽

Robotic Prostatectomy ◽

Robotic Technology ◽

Robotic Training ◽

Robotic Assisted ◽

Open Radical Prostatectomy ◽

Robotic Assisted Radical Prostatectomy ◽

The Cost

Abstract Aim To investigate the cost-effectiveness of robotic technology in robotic-assisted radical prostatectomy in comparison with laparoscopic radical prostatectomy and open radical prostatectomy. Methods The British Association of Urology Surgeons database (2014–2016) and Cancer Research UK (2012–2014) were accessed in conjunction with media; keywords included: ‘Da Vinci’, ‘first robotic prostatectomy’, ‘hospital’ to estimate the cost-effectiveness of robotic-assisted radical prostatectomy in the National Health Service. Results Approximately 12/43 (27.9%) centres achieved 150 robotic-assisted radical prostatectomies per year while 26/43 (60.4%) centres have managed to meet 100 robotic-assisted radical prostatectomies per year in 2014–2016. A national mean of 120–130 robotic-assisted radical prostatectomies per year for 2014–2016 was estimated. Conclusion The cost of robotic-assisted radical prostatectomy is adequately justified if a high volume of surgeries (>150) are performed in high volume centres by high volume experienced surgeons per year. This can be achieved by subsidising the cost of robotic technology, centralisation and establishing robotic training centres.

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