Cost Analysis of Pancreaticoduodenectomy at a High-Volume Robotic Hepatopancreaticobiliary Surgery Program.

Abstract Introduction The robotic approach to pancreaticoduodenectomy is thought by many to be associated with increased financial burden for hospitals. We undertook this study to analyze and compare the cost of ‘open’ pancreaticoduodenectomy to that associated with the application of the robotic surgical system to pancreaticoduodenectomy in our hepatobiliary program. Methods With IRB approval, all patients undergoing pancreaticoduodenectomy at our institution, from August 2012 to November 2019, were prospectively followed. Cost, including total, variable, fixed- direct, fixed-indirect, and profitability for robotic and ‘open’ pancreaticoduodenectomy were analyzed and compared. Data are presented as median (mean ± SD). Results 386 patients underwent pancreaticoduodenectomy, 205 patients underwent robotic pancreaticoduodenectomy and 181 underwent ‘open’ pancreaticoduodenectomy. Overall, cost of care for robotic pancreaticoduodenectomy was $31,389 (36,611 ± 20,545.4) versus $23,132 (31,323 ± 28,885.5) for ‘open’ pancreaticoduodenectomy (p=0.04); total variable cost was $20,355 (22,747 ± 11,127.6) versus $11,680 (16,032 ± 14,817.2) (p=0.01), total fixed direct cost was $1,999 (2,330 ± 1,363.1) versus $2,073 (2,983 ± 3,209) (p=0.01), and total indirect cost was $7,217 (9,354 ± 6,802.4) versus $6,802 (9,505 ± 9,307.2) (p=0.86), for robotic versus ‘open’ pancreaticoduodenectomy, respectively. Since 2016 profitability was achieved in 29% of patients undergoing robotic pancreaticoduodenectomy Conclusion Robotic pancreaticoduodenectomy had lower EBL and shorter LOS. Cost of care for robotic pancreaticoduodenectomy was greater across all categories, except for total indirect cost, than ‘open’ pancreaticoduodenectomy. For our institution, profitability was accomplished in less than a third of patients undergoing robotic pancreaticoduodenectomy. The role of the robotic platform for pancreaticoduodenectomy needs to be a discussion among all stakeholders.