title: Single institutional cost analysis of 325 robotic, laparoscopic, and open partial nephrectomies.
abstract: OBJECTIVE
  To compare costs associated with partial nephrectomy (PN) using robotic, laparoscopic (LPN), and open (OPN) approaches.
  
  
  METHODS
  An Investigational Review Board-approved prospectively maintained database was reviewed for 325 patients who underwent PN at our institution from January 2009 to December 2010. Costs for each surgical technique were itemized, including hospitalization, operating room (OR), anesthesia, medication, laboratory and pathology, professional fees, and blood bank. Continuous variables were analyzed with Kruskal-Wallis and Wilcoxon tests, and categoric variables were analyzed with χ(2) and Fisher exact tests.
  
  
  RESULTS
  Median costs of RPN were higher than LPN ($632, P = .005), but not significantly higher than OPN ($313, P = .14). The major cause of this difference was OR instrumentation and supplies. OR costs for LPN and OPN were equivalent (P = .11). The cost associated with anesthesia was significantly lower for RPN and LPN than for OPN (P = .002). RPN and LPN had lower hospitalization costs than OPN (P <.0001), which was largely due to the shorter hospital stay (P <.0001) and lower laboratory cost (P <.0001). Pharmacy costs and blood bank costs were not significantly different among groups (P = .09 and P = .48, respectively).
  
  
  CONCLUSIONS
  RPN had higher operating room costs than LPN and OPN, primarily due to instrumentation and supplies. This higher cost was offset by decreased cost of hospitalization in compared with the OPN group. Modification of practices aimed at lowering RPN instrumentation and supply costs may enable cost equivalence.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kassab
authors.forename: Rachid
authors.initials: R
authors.lastname: Yakoubi
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Ali
authors.initials: A
authors.lastname: Khalifeh
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
authors.forename: Amr
authors.initials: A
authors.lastname: Fergany
authors.forename: Matthew
authors.initials: M
authors.lastname: Simmons
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics*; D055815:Young Adult