Cost drivers of gastric sleeve procedures performed using robotic platform

Abstract

BACKGROUND: Robotic bariatric surgery adoption rates have increased, and the higher costs associated with robotic sleeve gastrectomy (rSG) are a concern. OBJECTIVES: To investigate the factors associated with increased costs of rSG. SETTING: US hospital database. METHODS: Patients who underwent rSG between January 1, 2018 and December 31, 2022 were extracted from PINC AI Healthcare Data. Inpatient total, variable, and fixed costs were converted to 2022 USD. Factors including patients and provider characteristics, types of staplers used (laparoscopic bedside staplers [LBS], other unspecified bedside staplers [OBS], and robotic staplers [RS]) were evaluated. Univariate and bivariate analyses were used to examine baseline balance among groups. Multivariable general linear model was used to identify cost drivers. RESULTS: There were 27,778 patient records, of which 25.6% used LBS, 10.3% used OBS, and 64.1% were RS cases. Increased costs were driven by type of stapler, patients aged 55-64, male, non-White race, non-Medicare insurance, higher comorbidity, and disease severity, and hospitals in West region, rural, more than 500 beds, with the lower hospital and surgeon's volume. After adjusting for other cost drivers, the procedures done by LBS significantly reduced variable costs by $651 ± $86 (mean difference ± standard error) and $564 ± $54 and fixed costs by $1716 ± $62 and $2297 ± $54 compared to OBS and RS. In total, the use of LBS significantly reduced total inpatient costs by $2384 ± $118 and $2692 ± $90 compared to OBS and RS, respectively. Also, LBS had fewer blood transfusions and intensive care unit visits than OBS and RS. CONCLUSIONS: RS and OBS were critical cost drivers in patients undergoing rSG compared to major brand bedside staplers.