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Published in: Langenbeck's Archives of Surgery 5/2022

Open Access 21-03-2022 | Pancreatectomy | Original Article

Robotic versus open pancreatic surgery: a propensity score-matched cost-effectiveness analysis

Authors: Christian Benzing, Lea Timmermann, Thomas Winklmann, Lena Marie Haiden, Karl Herbert Hillebrandt, Axel Winter, Max Magnus Maurer, Matthäus Felsenstein, Felix Krenzien, Moritz Schmelzle, Johann Pratschke, Thomas Malinka

Published in: Langenbeck's Archives of Surgery | Issue 5/2022

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Abstract

Background

Robotic pancreatic surgery (RPS) is associated with high intraoperative costs compared to open pancreatic surgery (OPS). However, it remains unclear whether several advantages of RPS such as reduced surgical trauma and a shorter postoperative recovery time could lead to a reduction in total costs outweighing the intraoperative costs. The study aimed to compare patients undergoing OPS and RPS with regards to cost-effectiveness in a propensity score-matched (PSM) analysis.

Methods

Patients undergoing OPS and RPS between 2017 and 2019 were included in this monocentric, retrospective analysis. The controlling department provided financial data (costs and revenues, net loss/profit). A propensity score-matched analysis was performed or OPS and RPS (matching criteria: age, American society of anesthesiologists (ASA) score, gender, body mass index (BMI), and type of pancreatic resection) with a caliper 0.2.

Results

In total, 272 eligible OPS cases were identified, of which 252 met all inclusion criteria and were thus included in the further analysis. The RPS group contained 92 patients. The matched cohorts contained 41 patients in each group. Length of hospital stay (LOS) was significantly shorter in the RPS group (12 vs. 19 days, p = 0.003). Major postoperative morbidity (Dindo/Clavien ≥ 3a) and 90-day mortality did not differ significantly between OPS and RPS (p > 0.05). Intraoperative costs were significantly higher in the RPS group than in the OPS group (7334€ vs. 5115€, p < 0.001). This was, however, balanced by other financial categories. The overall cost-effectiveness tended to be better when comparing RPS to OPS (net profit—RPS: 57€ vs. OPS: − 2894€, p = 0.328). Binary logistic regression analysis revealed major postoperative complications, longer hospital stay, and ASA scores < 3 were linked to the risk of net loss (i.e., costs > revenue).

Conclusions

Surgical outcomes of RPS were similar to those of OPS. Higher intraoperative costs of RPS are outweighed by advantages in other categories of cost-effectiveness such as decreased lengths of hospital stay.
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Metadata
Title
Robotic versus open pancreatic surgery: a propensity score-matched cost-effectiveness analysis
Authors
Christian Benzing
Lea Timmermann
Thomas Winklmann
Lena Marie Haiden
Karl Herbert Hillebrandt
Axel Winter
Max Magnus Maurer
Matthäus Felsenstein
Felix Krenzien
Moritz Schmelzle
Johann Pratschke
Thomas Malinka
Publication date
21-03-2022
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 5/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-022-02471-2

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