Trends and predictors of hospital charges in liver and pancreatic surgery: A comparative analysis of open, laparoscopic, and robotic approaches

Abstract

Background: Minimally invasive hepatic and pancreatic surgery remain underutilized, partly due to perceived higher costs. This study compared hospital charges among patients undergoing hepatic and pancreatic resection via open, laparoscopic, or robotic approaches.

Methods: Adult patients undergoing elective hepatic or pancreatic resections were identified from the Nationwide Readmissions Database (2016-2020). Data were stratified by surgical approach into open, laparoscopic, and robotic. Data were compared relative to baseline characteristics and outcomes. Multivariable quantile regression assessed associations between surgical approach and hospital charges, stratified by procedure type and discharge timing.

Results: Among 54,174 patients (median age 63 years; 51.3% female), 87.7% underwent open surgery, 9.3% underwent laparoscopic surgery, and 3.0% underwent robotic surgery. Use of robotic surgery increased from 1.7% (2016) to 4.2% (2020). Both laparoscopic (median $77,657) and robotic (median $89,713) surgery were associated with lower charges compared with open surgery (median $111,051) (P < .001). In liver-specific models, laparoscopic surgery was associated with lower adjusted charges overall (β -$23,564, 95% confidence interval -$26,014 to -$21,114), with the largest reductions among early discharges (β -$14,140, 95% confidence interval -$15,926 to -$12,353). Robotic liver surgery also resulted in lower overall charges (β -$8,430, 95% confidence interval -$15,710 to -$1,151). In pancreas-specific models, both laparoscopic surgery (β -$52,120) and robotic surgery (β -$30,758) were associated with lower overall charges. Complications (+$83,816) and late discharge (+$82,039) were the strongest predictors of increased charges.

Conclusion: For hepatopancreatic resections, minimally invasive approaches were associated with lower hospital charges. With favorable clinical and economic outcomes, adoption of minimally invasive surgery should be promoted.