Background

This study investigates the factors associated with increased costs of gastric sleeve robotic procedures.

Methods

Patients who underwent gastric sleeve robotic procedures between 1/1/2018 and 12/31/2022 were extracted from PINC AI™ Healthcare Data. Total inpatient cost, variable, and fixed costs were converted to 2022 USD using the consumer price index of hospital services. Factors including patients and provider characteristics, types of staplers used (laparoscopic (Ethicon and Medtronic) bedside staplers (LBS), other unspecified bedside staplers (OBS), and robotic staplers [RS]) were evaluated. Univariate and bivariate analyses were used to examine baseline balance among groups. Multivariable general linear model was used to identify cost drivers.

Results

There were 27,778 discharges, including 25.6% LBS, 10.3% OBS, and 64.1% RS cases. Cost drivers included type of staplers, patients aged 55-64, male, with non-White race, Medicaid or private insurance, higher comorbidity, and disease severity, and providers in West region, rural, 500+ beds, with lower provider volume, and lower surgeon's volume. After adjusting other cost drivers, the procedures done by LBS significantly reduced variable costs by $651+-$86 (Mean difference +- Standard error) and $564+-$54 and fixed costs by $1,716+-$62 and $2,297+-$54 compared to OBS and RS. In total, the LBS significantly reduced total inpatient cost by $2,384+-$118 and $2,692+-$90 compared to OBS and RS, respectively. Also, LBS has fewer blood transfusions and ICU visits than OBS and RS.

Conclusions

Robotic staplers and other unspecified bedside staplers were critical cost drivers in patients treated with gastric sleeve robotic procedures compared to major brand bedside staplers.