title: Robotic telepresence: profit analysis in reducing length of stay after laparoscopic gastric bypass.
abstract: BACKGROUND
  With the continuing rise of health-care costs, lowering inpatient length of stay can help managers and hospital administrators cope with the financial pressures and challenges of anticipated unfavorable operating margins. The goal of this study was to assess the financial impact of postoperative robotic telerounding on length of stay of all patients undergoing noncomplicated laparoscopic gastric bypass operations.
  
  
  METHODS
  We retrospectively reviewed 376 patients who underwent laparoscopic gastric bypass for morbid obesity from January 2004 to July 2006. The first 284 patients (group A) were assessed by bedside visits alone during the postoperative period. The second group (group B) consisted of 92 patients assessed by robotic telepresence combined with regular bedside visits before their discharge. Eleven patients were excluded from the study because they suffered from postoperative complications during the same admission.
  
  
  RESULTS
  After robotic rounds, 71 patients (77%) were discharged on postoperative day 1 (group B) and 218 patients (77%) assessed exclusively by bedside rounds were discharged on day 2 (group A). Mean length of stay was reduced from 2.33 days for group A to 1.26 days for group B. Early discharge created capacity for an additional 71 patient/days, although only 54 beds (76%) were reoccupied by new patients, representing a total financial gain of $219,578. Additionally, total room and board savings of $14,378 were realized as early discharge. Readmission rates within 7 days after discharge were 2% for group A and 1% for group B.
  
  
  CONCLUSIONS
  Robotic telerounding substantially reduces length of stay of patients undergoing noncomplicated laparoscopic gastric bypass operation. Telepresence technology applied in these settings had a substantial financial impact by reducing variable cost and creating capacity for growth and income.
authors.affiliation: Division of Bariatric and Minimally Invasive Surgery, Sinai Hospital of Baltimore, and The Johns Hopkins School of Professional Studies in Business and Education, Baltimore, MD 21215, USA. agandsas@lifebridgehealth.org
authors.forename: Alex
authors.initials: A
authors.lastname: Gandsas
authors.forename: Mitesh
authors.initials: M
authors.lastname: Parekh
authors.forename: Michele M
authors.initials: MM
authors.lastname: Bleech
authors.forename: Dalton A
authors.initials: DA
authors.lastname: Tong
mesh_terms: D015390:Gastric Bypass; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics*; D009767:Obesity, Morbid / Q000601:surgery*; D011182:Postoperative Care / Q000191:economics; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics*; D016896:Treatment Outcome