Time-Driven Activity-based Costing and Outcomes of Same-Day Discharge vs Inpatient Robotic Partial and Radical...

Area of Science:

• Urology
• Surgical Oncology
• Health Economics

Background:

• Robotic-assisted surgery is increasingly utilized for partial and radical nephrectomies.
• Assessing the economic and clinical implications of same-day discharge (SDD) versus inpatient stays is crucial for optimizing healthcare delivery.

Purpose of the Study:

• To evaluate outcomes, healthcare utilization, and cost savings associated with same-day discharge (SDD) compared to inpatient robotic-assisted partial nephrectomy (RAPN) and robotic-assisted radical nephrectomy (RARN).

Main Methods:

• A comparative study analyzed 146 RAPNs and 65 RARNs performed as SDD or inpatient procedures across two academic medical centers.
• Data collected included demographics, perioperative characteristics, and 30-day complications.
• Time-Driven Activity-Based Costing (TDABC) was employed to compare total costs for both procedures under SDD and inpatient models.

Main Results:

• No significant differences in baseline demographics or comorbidities were observed between inpatient and SDD groups.
• Complication rates were low, with one readmission for wound infection after SDD RAPN and no complications after SDD RARN.
• SDD RAPN and RARN demonstrated substantial cost reductions of 18% ($3091) and 25% ($4003), respectively.

Conclusions:

• Same-day discharge for both robotic-assisted partial and radical nephrectomies leads to significant cost savings (18%-25%) without compromising patient safety.
• SDD improves value-based care by reducing costs while maintaining comparable complication profiles for appropriately selected patients.