Cost comparison of open and robotic partial nephrectomy using a short postoperative pathway Journal Article


Authors: Mano, R.; Schulman, A.; Hakimi, A. A.; Sternberg, I. A.; Bernstein, M.; Bochner, B. H.; Coleman, J. A.; Russo, P.
Article Title: Cost comparison of open and robotic partial nephrectomy using a short postoperative pathway
Abstract: Objective To compare immediate perioperative direct costs of open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN), managed under a common care pathway. Methods Retrospective review of detailed institutional cost data for patients treated with OPN and RPN during 2011 was conducted. Cost and clinical data of OPN and RPN were compared for all patients and for patients stratified by length of stay (LOS), American Society of Anesthesiologists (ASA), and RENAL nephrometry scores. Results The study cohort included 190 OPN and 63 RPN cases. OPN was associated with higher ASA scores (P <.001), shorter operative times (P =.014), and higher estimated blood loss (P <.001). Median (interquartile range) LOS was 2 days (2-3 days) for OPN compared with 1 day (1-2 days) for RPN (P <.001). Median perioperative cost of OPN was lower than that of RPN with a difference of $3091 (P <.001). Although hospitalization costs were higher in OPN, surgical costs were higher in RPN ($854 and $3695 difference in median costs, respectively; P <.001 for both). The total cost of OPN for patients with an above-average LOS remained lower than that of RPN ($2680 difference in median costs; P =.001). RPN costs remained significantly higher when stratifying patients by their ASA and RENAL nephrometry scores. Conclusion Despite the shorter hospital LOS associated with RPN, the immediate perioperative cost of OPN was lower than that of RPN for patients managed under a common care pathway, mainly due to high robotic purchase and maintenance costs. In light of the current health care debate, such financial disincentives may compromise the sustainability of advances in medical technology. © 2015 Elsevier Inc.
Keywords: adult; aged; surgical technique; major clinical study; postoperative period; retrospective study; postoperative complication; length of stay; partial nephrectomy; operation duration; medical society; perioperative period; hospitalization cost; open partial nephrectomy; robotic partial nephrectomy; operative blood loss; human; male; female; priority journal; article
Journal Title: Urology
Volume: 85
Issue: 3
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2015-03-01
Start Page: 596
End Page: 603
Language: English
DOI: 10.1016/j.urology.2014.10.044
PROVIDER: scopus
PUBMED: 25586478
DOI/URL:
Notes: Export Date: 4 May 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Jonathan Coleman
    192 Coleman
  2. Paul Russo
    457 Russo
  3. Bernard Bochner
    327 Bochner
  4. Abraham Ari Hakimi
    134 Hakimi
  5. Roy Mano
    24 Mano