Length of stay and nhi-reimbursed expenditures after robotic-assisted surgery in taiwan: a nationwide population-based study

Population-level evidence comparing robotic-assisted surgery (RAS) with laparoscopic surgery (LS)/video-assisted thoracoscopic surgery (VATS) and open surgery (OS) across multiple procedures from a payer perspective remains limited. This study aimed to compare postoperative length of stay (LOS) and insurer-reimbursed in-hospital expenditures among RAS, LS/VATS, and OS across representative procedures following the expansion of RAS reimbursement in Taiwan. This retrospective nationwide population-based cohort study was conducted using claims data from Taiwan's National Health Insurance Research Database. We identified adults (age ≥ 18 y) who underwent 1 of 12 representative procedures spanning thoracic, hepatobiliary-pancreatic, colorectal, urologic, and gynecologic specialties between September 1 and December 31, 2024. Surgical approaches were classified as robotic-assisted surgery (RAS), laparoscopic or video-assisted thoracoscopic surgery (LS/VATS), or open surgery (OS) using the corresponding procedure and robotic-assistance codes in the NHI claims database. The outcomes were postoperative LOS and total NHI-reimbursed in-hospital expenditures excluding special medical materials during the index hospitalization. Procedure-specific stabilized inverse probability of treatment weighting was applied to each pairwise comparison. This study included 17 549 patients. Of these patients, 2900, 9763, and 4886 underwent RAS, LS/VATS, and OS, respectively. RAS was associated with a significantly shorter postoperative LOS than LS/VATS for lung resection, colectomy, partial nephrectomy, and nephroureterectomy and with lower reimbursed expenditures for lung resection, partial pancreatectomy, nephroureterectomy, and radical prostatectomy. Compared with OS, RAS was associated with a significantly shorter postoperative LOS for selected procedures, with the largest difference noted for colectomy (8.38 vs. 14.80 d). Moreover, RAS was associated with lower reimbursed expenditures than OS for lung resection, minor hepatectomy, partial pancreatectomy, colectomy, and malignant hysterectomy. During the early period following the September 2024 expansion of NHI reimbursement for RAS in Taiwan, RAS was associated with shorter postoperative LOS for selected procedures, whereas differences in NHI-reimbursed in-hospital expenditures excluding special medical materials varied by procedure and comparator. Given the observational study design, residual confounding, and limited propensity-score overlap in several comparisons, particularly RAS versus OS, these findings should be interpreted as procedure-specific associations rather than evidence of clinical or economic superiority.