• Annals of surgery · Feb 2025

    Cost-analysis of Implementing robot-assisted Versus Open Pancreatoduodenectomy.

    • Julia E Menso, Michiel F G Francken, Nine de Graaf, Alessandro M Bonomi, Riccardo Guastella, Dylan Balaban, Mahsoem Ali, H Jaap Bonjer, Susan van Dieren, DijkgraafMarcel G WMGWAmsterdam UMC, location University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands., Jony van Hilst, Gabriela Pilz da Cunha, Joris Erdmann, Geert Kazemier, Rutger-Jan Swijnenburg, Barbara M Zonderhuis, Freek Daams, Sebastiaan Festen, Olivier R Busch, Marc G Besselink, and for HPB-Amsterdam.
    • Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
    • Ann. Surg. 2025 Feb 10.

    ObjectiveTo perform a cost-analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center.BackgroundMany high-volume centers are implementing RPD as alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.MethodsPost-hoc cost-analysis of consecutive RPD versus OPD in a singly high-volume center (Jan 2015-May 2024). The eligibility criteria for RPD (i.e. no vascular contact, no chronic and necrotizing pancreatitis, and BMI<35 kg/m2) were used to select patients undergoing OPD, to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience.ResultsOverall, 588 patients undergoing pancreatoduodenectomy were included (214 RPD, 374 OPD). Total hospital stay was shorter after RPD (10 [6-17] vs. 12 [8-21] days, P=0.001). Mean total hospital costs were €4,804 higher for RPD (€27,307 vs. €22,503, P=0.010). Outcomes improved in the second half of the RPD experience (n=107): total hospital stay (12 [7-23] to 9 [6-15] days, P<0.001), pancreatic fistula (48.6% to 31.8%, P=0.012), delayed gastric emptying (33.6% to 15.0%, P=0.001), and operative time (373 [341-411] to 310 [272-352] minutes, P<0.001). Consequently, costs per RPD procedure decreased with €11,058 (€32,836 to €21,778, P=0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P=0.210). Hence, total costs for RPD and OPD became comparable in the second half (€21,778 vs. €21,013, P=0.644).ConclusionImplementing RPD is associated with considerable additional costs compared to OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large scale randomized trials will have to confirm these findings.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?

    User can't be blank.

    Content can't be blank.

    Content is too short (minimum is 15 characters).

    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…