Use, Cost, and Comparative Effectiveness of Robotic Versus Laparoscopic and Open Cholecystectomy at U.S. Hospitals

Cholecystectomy remains one of the most commonly performed abdominal surgeries with \u3e1million/yr. procedures performed in US hospitals. Open cholecystectomy(OC), Laparoscopic cholecystectomy(LC) and Robotic cholecystectomy(RC) are three surgical options available, with RC the latest option approved in 2011. There is a paucity of comparative effectiveness research (CER) on clinical outcomes between these three surgical modalities in US hospitals. This dissertation study sought to address this gap by conducting a retrospective analysis of six yrs. (2010 – 2015) hospital discharge data from National Inpatient Sample (NIS). This study aims to examine the trends in adoption of RC uptake in US hospitals, compare clinical outcomes (Length of Stay - LOS, Bile Duct Injuries - BDI and Mortality) between the three modalities of cholecystectomies in US hospitals and compare hospitalization costs associated with the three modalities of cholecystectomies. To evaluate the trends of adoption of RC, a weighted logistic regression model was estimated. Comparison of clinical outcomes (BDI and Mortality) was evaluated with a weighted logistic regression while a weighted Poisson regression was used to evaluate LOS. For the final aim a weighted log-linear model was used to compare the hospitalization costs between the three surgical modalities. Our analysis revealed a steady increase in the number of RC in US hospitals in the last 6yrs, alongside a reduction in the number of procedures for OC and LC in US hospitals. RC shows improved clinical outcomes with less LOS and reduced mortality associated with the procedure. Cholecystectomy hospitalization costs in the US was estimated to be over $30 billion over the 6yr study period with RC accounting for \u3c1% of the total cost ($297 million) compared to the declining rate in both total costs associated with OC ($7 billion) and LC ($22 billion) with both procedures having - \u3e55% and \u3e49% drop in the total costs respectively. In summary, this dissertation study makes an important contribution to CER by using administrative data to compare clinical outcomes between three surgical modalities of cholecystectomy in US hospitals and costs assessment which is a precursor for full evaluation of the efficiency of investing in innovative technologies.