Total cost of care of robotic-assisted surgery in an integrated delivery network in Eastern Pennsylvania.

INTRODUCTION: Adoption of robotic-assisted surgery (RAS) is limited due to several factors including access and cost. Our aim is to evaluate the total cost of care by analyzing key performance indicators and contribution margins of RAS in our healthcare system. METHODS: We included patients > 18 yo who underwent open, laparoscopic (Lap), and robotic-assisted procedures (Robotic) between June 2020 and July 2023. Key performance Indicators included operating room (OR) time, hospital length of stay (LOS), ICU admission, conversion to open, 30-day readmission, and surgical site infection (SSI). Contribution margins (CM) and CM/LOS were calculated. Statistical analyses included analysis of variance (ANOVA), the Kruskal-Wallis test, and the Chi-square test. RESULTS: The total number of addressable procedures was 14,315. Compared to Lap, robotic procedures were associated with significantly shorter LOS, conversion to open rate, and SSI (1 vs 2 days; 1.9% vs 5.1%; and 0.1 vs 1.5%, respectively, p < 0.05). However, we found no difference in 30-day readmission and ICU admission rates. Compared to open, robotic procedures were associated with significantly shorter LOS, 30-day readmission, ICU admission, and SSI rates (2 vs 5 days; 3.8% vs 7.2%; 0.9% vs 22.1%; and 0.2% vs 1.9%, respectively, p < 0.05). For inpatient colon resection, there was no difference in CM among the three groups (p > 0.05). However, CM/LOS was significantly higher for lap compared to open procedures (2929.15 $ vs 1708.97$, p < 0.05). For outpatient cholecystectomy, inguinal and ventral hernias CM were higher in the robotic group compared to the open and lap ones, but the difference was not statistically significant. For RYGB and SG, both CM and CM/LOS were significantly higher for RAS procedures. CONCLUSION: Our study showed that RAS can result in improved clinical outcomes with similar or higher contribution margins suggesting that robotic-assisted surgery can potentially result in lower total cost of care.