Open versus robot-assisted laparoscopic ureteral reimplantation: Hospital charges analysis and outcomes at a single institution

Rodolfo A Elizondo; Jason K Au; Sang Hoon Song; Gene O Huang; Wei Zhang; Huirong Zhu; Nicolette Janzen; Abhishek Seth; David R Roth; Duong T Tu; Chester J Koh

doi:10.1016/j.jpedsurg.2019.12.016

Open versus robot-assisted laparoscopic ureteral reimplantation: Hospital charges analysis and outcomes at a single institution

J Pediatr Surg. 2020 Jan 9:S0022-3468(19)30901-7. doi: 10.1016/j.jpedsurg.2019.12.016. Online ahead of print.

Authors

Affiliations

¹ Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
² Department of Surgery (Urology), University of Texas John P. and Kathrine G. McGovern Medical School, Houston, Texas, USA.
³ Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
⁵ Department of Biostatistics & Data Science, University of Texas HSC, School of Public Health, Houston, Texas, USA.
⁶ Outcomes and Impact Service, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
⁷ Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA. Electronic address: cxkoh@texaschildrens.org.

PMID: 31955989
DOI: 10.1016/j.jpedsurg.2019.12.016

Abstract

Purpose: Robot-assisted laparoscopic extravesical ureteral reimplantation has previously been described as a viable minimally invasive option to open surgery. However, concerns for robotic surgery have been raised owing to assumed higher costs and heterogeneous clinical outcomes. We hypothesized that similar hospital charges and clinical outcomes occur when comparing open and robotic cases in matched cohorts.

Materials and methods: Open and robotic reimplantation cases from 2013 to 2015 for primary vesicoureteral reflux were matched by age using 1:1 nearest neighbor matching. The matched cohorts were analyzed and compared for their direct itemized hospital charges per surgical case, complications, and clinical outcomes.

Results: There were 38 patients in each group after age-matching the 135 patients. Operating room charges were higher for the robotic group compared to the open group (p=0.002), whereas pharmacy and laboratory costs were lower for the robotic group. However, there were no significant differences in total overall charges between the open and robotic groups with cystoscopy or without cystoscopy (p=0.345, p=0.533), since the median hospital stay length was shorter for the robotic group (p<0.001). Clinical success rates were identical for the two groups (open 94.8% vs robotic 94.8%). There were also no significant differences in number of complications between the two cohorts.

Conclusions: This is the first age-matched study comparing hospital charges and clinical outcomes of pediatric open and robotic reimplantation. While operating room charges were higher for the robotic cohort, lower hospitalization charges led to comparable overall hospital charges, as well as equivalent clinical outcomes for both cohorts.

Level of study: Level III (Retrospective comparative study) TYPE OF STUDY: Retrospective Study.

Keywords: Hospital charges; Pediatrics; Robotic surgery procedures; Ureteral reimplantation; Vesicoureteral reflux.