Impact of the robotic platform and surgeon variation on cholecystectomy disposable costs-More is not better.

Abstract

Background: We hypothesized that surgeon variation in equipment and platform during cholecystectomy would increase costs without measurable benefit.

Methods: We retrospectively reviewed all cholecystectomies from a large health care system. Using a mixed model, we modeled disposable instrument costs and outcomes. Independent variables included patient, hospital, surgeon factors and the surgical platform.

Results: From 2017 to 2024, we analyzed 13,548 laparoscopic cholecystectomies and 1,258 robotic cholecystectomies performed by 98 surgeons across 14 hospitals. The proportion of robotic cholecystectomy usage increased from 0.1% in 2017 to 26% (522 of 2021) in 2024. The unadjusted disposable cost (mean, median, and the 25th percentile) was $669 ± $4.2, $534, and $448 for laparoscopic cholecystectomy and $1,447 ± $18, $1,309, and $1,120 for robotic cholecystectomy, respectively. The cheapest surgeon's mean cost was $272 ± $37 (n = 16), and the most expensive was $1,934 ± $108 (n = 223), both laparoscopic only. For robotic cholecystectomies, the least costly surgeon averaged $1,062 ± $23 (n = 52). Using our mixed models, robotic cholecystectomy was on average $817 ± $22 more expensive than laparoscopic cholecystectomy (P < .001); there was no meaningful difference in mean operating room times, readmission rates, length of stay, or 30-day reintervention rate between surgical platforms. However, robotic cholecystectomies predicted a substantially lower conversion rate (odds ratio: 0.20 ± 0.11, P = .004) or $93,000 per conversion prevented. If all surgeons operated at the 25th percentile of a platform's mean cost, a potential disposal equipment savings of 35% for laparoscopic cholecystectomy and 24% for robotic cholecystectomy could be realized.

Conclusion: Robotic cholecystectomy costs were 2.5 times greater than those for laparoscopic cholecystectomy. In addition, surgeons' disposable equipment choices also substantially impact cholecystectomy costs. Neither platform nor excess costs provide any substantial measurable outcome benefit.