Hemostatic Supplies and Instruments Do Not Appear to Improve Outcomes of Robotic Prostatectomy

As the medical field strives towards improved value-based care, identifying cost drivers that do not improve outcomes is critical. Robotic assisted laparoscopic prostatectomy (RALP) is a common, costly urologic procedure with variable intraoperative supply utilization. We evaluated whether use of high-cost hemostatic agents and instruments improves perioperative outcomes.

We performed a retrospective study of 4,573 patients undergoing RALP (2018-2025). Supply costs were categorized as fixed or variable. Hemostatic agents and instruments were identified as major variable cost drivers. Primary outcome was 30-day transfusion; secondary outcomes included hemoglobin change, bleeding-related readmission, operative time, length of stay, emergency department visits, and lymphocele. Multivariable and mixed-effects models accounted for patient and surgeon factors.

Median supply cost per case was 151.7% of fixed items [IQR 128.5%-182.6%], with substantial inter-surgeon variation. Hemostatic agents were used in 75.9% of cases (+13.1% cost), staplers in 37.5% (+23.5%) and vessel sealers in 35.8% (+25.0%). Transfusion (0.5%) and bleeding-related readmission (0.4%) were rare. Neither hemostatic agents nor instruments were associated with transfusion, readmission, or hemoglobin change. When adjusting for patient and surgeon level factors, hemostatic agents increased operative time by 9 minutes, while instruments decreased time by 11 minutes. No differences were observed in length of stay, ED visits, or lymphocele rates.

Despite frequent use and significant cost contribution, hemostatic agents and instruments were not associated with improved bleeding or perioperative outcomes in RALP. Routine use, particularly of topical agents, may represent low-value care and highlight an opportunity to reduce costs without compromising patient outcomes.