A Cohort Study Comparing Cost-Efficiency of Abdominal and Robotic Sacrocolpopexy

To compare cost and reimbursement of robotic and abdominal sacrocolpopexy procedures to evaluate which approach may minimize costs while improving the hospital profit margin.

We performed an IRB-exempt retrospective cohort study investigating all patients who underwent robotic or abdominal sacrocolpopexy at our hospital between July 1, 2018 and May 31, 2022. Patient demographic, procedural, and postoperative course data were extracted via chart review including duration of procedure, time in operating room, complications, and length of hospital stay. The billing department provided information on estimated cost of stay and reimbursement rates.

A total of 203 robotic and 291 abdominal cases were included in analysis. The groups had significant differences in demographics, including race and insurance status. Abdominal procedures were associated with lower costs ($7675.99 vs 8747.48, P <.0001) and higher reimbursement rates ($ 16,210.48 vs $ 10,102.28, P <.0001), with the total collected (reimbursement minus cost), or profit margin, differing significantly ($8534.50 vs $1354.80, P <.0001). Discrepancies in reimbursement and profit remained after controlling for secondary procedures. Abdominal cases also had shorter average duration (129.9 vs 168.4 minutes, P <.0001). Abdominal sacrocolpopexy was associated with higher estimated blood loss (109.2 vs 97.9, P <.0001) and longer hospital stay (26.3 vs 15.9 hours, P <.0001).

Despite longer hospital stays and slightly higher estimated blood loss, abdominal sacrocolpopexy appears to have lower costs and higher reimbursement rates than robotic sacrocolpopexy, with a higher profit margin for the hospital.