Validated cost comparison of open vs. robotic pyeloplasty in American children's hospitals

The objective of this study is to determine the cost and charge differences between patients undergoing open vs. robotic pyeloplasty. This is a retrospective analysis of the Pediatric Health Information System (PHIS) database in patients undergoing pyeloplasty between 2004 and 2013 conducted in large pediatric children's hospitals in the United States which contribute to PHIS. The participants included all pediatric patients undergoing pyeloplasty at these institutions. We assessed RCC-based cost, charge details, length of stay, and the presence of complications, and compared them between open and robotic cases. When PHIS data were compared to matched local patients, all but five were perfectly matched by medical record number, demographics, and date of procedure. When we compared open vs. robotic cases in 18 institutions that commonly performed robotic cases, there was a similar age distribution, robotic cases had shorter length of stay (2.2 v, 1.6 days, p < 0.001), similar rates of surgical complications (open 4.5 %, robotic 3.6 %, p = 0.50), and robotic cases were more expensive by US $3991 (p < 0.001). OR charges and anesthesia charges accounted for the majority of the cost difference between open vs. robotic cases. There was no association between patient age or chronological year and the mean cost difference between open vs. robotic cases. Robotic pyeloplasty is more expensive, but has a lower (although non-significant) rate of complications and a significantly shorter length of stay. Charges for OR and anesthesia time dominate the cost difference; so efforts to reduce these specific costs should be the focus of future cost-containment efforts.