Robot‐assisted vs open adrenalectomy: evaluation of cost‐effectiveness and peri‐operative outcome

Objectives To compare robot‐assisted laparoscopic adrenalectomy ( RALA ) and open adrenalectomy ( OA ) with regard to intra‐operative complications, peri‐operative outcome and cost effectiveness. Subjects and Methods Functional and statistical data from patients who underwent OA or RALA between 2001 and 2015 were prospectively recorded including intra‐ and postoperative outcomes. Data on per‐day costs from current census reports (€540/day and €1 145/day for normal and intermediate care [ IMC ]) were also used to evaluate treatment costs. Additional costs for RALA were assumed at €2288 as reported in the current literature. Patients were matched by American Society of Anesthesiologists score, age, side of surgery and gender for comparison of OA and RALA . A total of 28 matched pairs were analysed with regard to patient characteristics, peri‐operative outcomes and cost‐effectiveness. Statistical significance of outcome variables was determined using Student's t ‐test and Pearson's chi‐squared test. Results As a result of the matching process, patient groups did not differ in their main characteristics. Length of hospital stay was shorter for RALA than for OA (11.1 ± 4.8 vs 6.8 ± 1.2 days; P < 0.01) as was IMC treatment (2.3 ± 1.7 vs 1.2 ± 0.4 days; P < 0.01). The mean operating time was longer for RALA (128.5 ± 46.5 vs 102.2 ± 44.5 min; P = 0.03), but the last 10 RALA procedures (mean: 97.1 ± 35.2 min) were similar to OA . The rate of complications was similar in the two groups. Estimated costs were €8 627.5 for OA and €7 334 for RALA . Conclusions The study showed that RALA was safe and cost‐effective compared with OA . Increasing experience leads to similar operating times, putting high‐volume centres at an advantage.