title: Human capital gains associated with robotic assisted laparoscopic pyeloplasty in children compared to open pyeloplasty.
abstract: OBJECTIVE
  Robotic assisted laparoscopic pyeloplasty is an emerging, minimally invasive alternative to open pyeloplasty in children for ureteropelvic junction obstruction. The procedure is associated with smaller incisions and shorter hospital stays. To our knowledge previous outcome analyses have not included human capital calculations, especially regarding loss of parental workdays. We compared perioperative factors in patients who underwent robotic assisted laparoscopic and open pyeloplasty at a single institution, especially in regard to human capital changes, in an institutional cost analysis.
  
  
  METHODS
  A total of 44 patients 2 years old or older from a single institution underwent robotic assisted (37) or open (7) pyeloplasty from 2008 to 2010. We retrospectively reviewed the charts to collect demographic and perioperative data. The human capital approach was used to calculate parental productivity losses.
  
  
  RESULTS
  Patients who underwent robotic assisted laparoscopic pyeloplasty had a significantly shorter average hospital length of stay (1.6 vs 2.8 days, p <0.05). This correlated with an average savings of lost parental wages of $90.01 and hospitalization expenses of $612.80 per patient when excluding amortized robot costs. However, cost savings were not achieved by varying length of stay when amortized costs were included.
  
  
  CONCLUSIONS
  Robotic assisted laparoscopic pyeloplasty in children is associated with human capital gains, eg decreased lost parental wages, and lower hospitalization expenses. Future comparative outcome analyses in children should include financial factors such as human capital loss, which can be especially important for families with young children.
authors.affiliation: Division of Pediatric Urology and the Biostatistical Core, Children's Hospital Los Angeles and University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90027, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Behan
authors.forename: Steve S
authors.initials: SS
authors.lastname: Kim
authors.forename: Frederick
authors.initials: F
authors.lastname: Dorey
authors.forename: Roger E
authors.initials: RE
authors.lastname: De Filippo
authors.forename: Andy Y
authors.initials: AY
authors.lastname: Chang
authors.forename: Brian E
authors.initials: BE
authors.lastname: Hardy
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000191:economics; D008297:Male; D010290:Parents; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D012371:Robotics; D012959:Socioeconomic Factors; D014481:United States; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000191:economics / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics / Q000379:methods*; D055815:Young Adult