Costs of robot-assisted vs. open approaches for 5 major cancers

To test for differences in total hospital cost (THC) between robot-assisted vs. open major cancer surgeries, colectomy, esophagectomy, radical hysterectomy, lung resection and pancreatectomy. Within the National Inpatient Sample (2016-2019), we identified all robot-assisted vs. open procedures for the above stated surgeries. Multivariable Poisson regression models were fitted. Of all surgeries, 6830 (14%) were robot-assisted colectomies, 333 (7%) esophagectomies, 5985 (24%) radical hysterectomies, 6500 (21%) lung resections and 449 (4%) pancreatectomies. Relative to open surgery, robot-assisted esophagectomy (181,462 vs. 96,195 $, Δ = 85,267 $), pancreatectomy (123,872 vs. 95,707 $, Δ = 28,168 $), lung resection (93,910 vs. 80,770 $, Δ = 13,140 $) and colectomy (82,898 vs. 71,279 $, Δ = 11,619 $) were associated with higher THC (all p < 0.001), except for radical hysterectomy (63,793 vs. 62,558 $, p = 0.8). After multivariable adjustment for patient and hospital characteristics, robot-assisted esophagectomy (risk ratio [RR]: 1.40), robot-assisted pancreatectomy (RR: 1.24), robot-assisted colectomy (RR: 1.20), robot-assisted lung resection (RR: 1.11) as well as robot-assisted radical hysterectomy (RR: 1.10) independently predicted higher THC (all p < 0.001). For the five examined procedures, THC are invariably higher when the robot-assisted approach is used. This THC disadvantage of the robot-assisted approach requires a careful consideration to the other benefits of robotic-assisted surgery, such as shorter convalescence and earlier return to regular activities, that could not be addressed in the current analysis.