The cost of conversion in robotic and laparoscopic colorectal surgery

Background Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbu...

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Bibliographic Details
Published in:	Surgical endoscopy 2018-03, Vol.32 (3), p.1515-1524
Main Authors:	Cleary, Robert K., Mullard, Andrew J., Ferraro, Jane, Regenbogen, Scott E.
Format:	Article
Language:	eng
Subjects:	Abdominal Surgery Adult Aged Collaboration Colon - surgery Colorectal surgery Conversion to Open Surgery - economics Databases, Factual Digestive System Surgical Procedures - economics Female Gastroenterology Gynecology Health Care Costs Hepatology Humans Laparoscopy Laparoscopy - economics Laparoscopy - methods Male Medicine Medicine & Public Health Michigan Middle Aged Physicians Proctology Rectum - surgery Retrospective Studies Robotic surgery Robotic Surgical Procedures - economics Robotic Surgical Procedures - methods Surgery
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Summary:	Background Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbursement reform and bundled payments expand perspectives on cost to include the entire surgical episode, we evaluated the role of minimally invasive conversion in total payments. Methods This is an observational study from a linked data registry including clinical data from the Michigan Surgical Quality Collaborative and payment data from the Michigan Value Collaborative between July 2012 and April 2015. We evaluated colorectal resections initiated with open and minimally invasive approaches, and compared reported risk-adjusted and price-standardized 30-day episode payments and their components. Results We identified 1061 open, 1604 laparoscopic, and 275 robotic colorectal resections. Adjusted episode payments were significantly higher for open operations than for minimally invasive procedures completed without conversion ($19,489 vs. $15,518, p
ISSN:	0930-2794 1432-2218