Contemporary Operative Trends and Outcomes of Laparoscopic and Robotic Heller Myotomy Using a Large National Database

Area of Science:

• Gastroenterology
• Surgical Innovation
• Health Economics

Background:

• Robotic-assisted Heller myotomy (RAHM) is gaining traction for achalasia treatment.
• Previous research suggests technical benefits of RAHM over laparoscopic Heller myotomy (LHM).
• Economic implications of RAHM versus LHM are not well-established.

Purpose of the Study:

• To compare hospitalization costs and clinical outcomes between RAHM and LHM.
• To analyze data from a nationally representative patient cohort.

Main Methods:

• Utilized the 2016-2021 Nationwide Readmission Database.
• Included adult patients undergoing LHM or RAHM for achalasia.
• Employed entropy balancing and multivariable linear regression for outcome analysis (mortality, readmission, costs, LOS).

Main Results:

• RAHM use increased, but LHM remained more common.
• No significant differences observed in mortality, length of stay (LOS), or 30-day readmissions between RAHM and LHM.
• RAHM resulted in higher index hospitalization costs ($19,387 vs $16,317, P < 0.001), a difference that persisted after adjustment (+$3,345).

Conclusions:

• RAHM and LHM yield comparable short-term clinical outcomes for achalasia.
• RAHM is associated with higher hospitalization costs.
• Further economic impact evaluations of RAHM are necessary.