J. B. Mahida1,2, J. N. Cooper1, D. Herz3, K. A. Diefenbach2, K. J. Deans1,2, P. C. Minneci1,2, D. J. McLeod1,3 1Nationwide Children’s Hospital,Center For Surgical Outcomes Research,Columbus, OH, USA 2Nationwide Children’s Hospital,Division Of Pediatric Surgery,Columbus, OH, USA 3Nationwide Children’s Hospital,Division Of Pediatric Urology,Columbus, OH, USA
Introduction: To evaluate current trends in the use and costs associated with robotic surgery at freestanding children’s hospitals.
Methods: We identified all patients less than 18 years of age in the Pediatric Health Information System (PHIS) database who underwent a robotic-assisted surgery between October 2008 and December 2013. After determining the six most frequently performed primary procedures in this group, we identified a cohort of patients who underwent equivalent open or laparoscopic procedures at the same hospitals over the same time period. We analyzed the overall frequencies and trends in the numbers of procedures performed over the study period and compared costs between patients undergoing robotic-assisted surgery and patients not undergoing robotic surgery for each of the six procedures.
Results: The six most common urologic or general surgery robotic-assisted cases performed were correction of ureteropelvic junction (UPJ) obstruction (n=760), ureteral reimplantation (n=351), nephrectomy (n=145), partial nephrectomy (n=56), gastrointestinal antireflux procedure (n=61), and cholecystectomy (n=46). The overall number of robotic-assisted surgeries performed at the 22 included hospitals increased by 19.8% per year (p<0.001); individual analyses of the six most commonly performed procedures revealed that this was primarily driven by significant increases in urologic procedures (17.4%/year, p<0.001). Differences in demographics, clinical characteristics, and length of stay between all patients undergoing robotic and non-robotic procedures are shown in the Table. Total hospital costs tended to be higher for robotic-assisted surgeries than comparable open or laparoscopic procedures (Urologic procedures median costs: robotic $14,583 vs. open $9,388, p<0.001) (General surgical procedures median costs: robotic $13,954 vs. laparoscopic $10,180, p<0.001).
Conclusion: Use of robotic-assisted surgery in pediatrics is increasing, especially in the management of urologic diseases. Costs of robotic-assisted surgery associated admissions were higher than non-robotic surgery associated admissions even though robotic procedures were associated with a shorter length of stay. Further analysis of specific procedure related outcomes and patient reported satisfaction, particularly for procedures that would otherwise be performed open, may be warranted in order to justify the increased cost of robotic surgery in children.
