Key result
Robotic-assisted surgery linked to shorter stays and lower morbidity but higher costs versus other approaches.
Why the study?
To compare surgical outcomes and in-hospital costs between robotic-assisted, laparoscopic, and open surgical approaches for benign gynaecology, colorectal, and urological patients, and to evaluate the association between cost and surgical complexity.
Does robotic-assisted surgery improve surgical outcomes and alter in-hospital costs compared to laparoscopic and open approaches in patients undergoing benign gynaecology, colorectal, and urological surgeries?
Cohort (n=1,271)
No
Does robotic-assisted surgery improve surgical outcomes and alter in-hospital costs compared to laparoscopic and open approaches in patients undergoing benign gynaecology, colorectal, and urological surgeries?
Robotic-assisted surgery improves perioperative outcomes such as length of stay and complication rates compared to open surgery, but at a significantly higher in-hospital cost.
Robotic surgery linked to shorter stays/lower morbidity at higher cost in this cohort; leaves open whether benefits justify adoption pending randomized trials.
This study aims to compare surgical outcomes and in-hospital cost between robotic-assisted surgery (RAS), laparoscopic and open approaches for benign gynaecology, colorectal and urological patients and to explore the association between cost and surgical complexity. This retrospective cohort study included consecutive patients undergoing RAS, laparoscopic or open surgery for benign gynaecology, colorectal or urological conditions between July 2018 and June 2021 at a major public hospital in Sydney. Patients' characteristics, surgical outcomes and in-hospital cost variables were extracted from the hospital medical records using routinely collected diagnosis-related groups (DRG) codes. Comparison of the outcomes within each surgical discipline and according to surgical complexity were performed using non-parametric statistics. Of the 1,271 patients included, 756 underwent benign gynaecology (54 robotic, 652 laparoscopic, 50 open), 233 colorectal (49 robotic, 123 laparoscopic, 61 open) and 282 urological surgeries (184 robotic, 12 laparoscopic, 86 open). Patients undergoing minimally invasive surgery (robotic or laparoscopic) presented with a significantly shorter length of hospital stay when compared to open surgical approach (P < 0.001). Rates of postoperative morbidity were significantly lower in robotic colorectal and urological procedures when compared to laparoscopic and open approaches. The total in-hospital cost of robotic benign gynaecology, colorectal and urological surgeries were significantly higher than other surgical approaches, independent of the surgical complexity. RAS resulted in better surgical outcomes, especially when compared to open surgery in patients presenting with benign gynaecology, colorectal and urological diseases. However, the total cost of RAS was higher than laparoscopic and open surgical approaches.
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Steffens et al. (2023) conducted a cohort in Benign gynaecology, colorectal, and urological conditions (n=1,271). Robotic-assisted surgery (RAS) vs. Laparoscopic and open surgical approaches was evaluated on Length of hospital stay (p=<0.001). Robotic-assisted surgery resulted in shorter hospital stays and lower morbidity in colorectal and urological procedures, but incurred significantly higher in-hospital costs than other approaches.
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