title: National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty.
abstract: OBJECTIVE
  We performed a population based study comparing trends in perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. Specific billing items contributing to cost were also investigated.
  
  
  METHODS
  Using the Perspective database (Premier, Inc., Charlotte, North Carolina), we identified 12,662 pediatric patients who underwent open, laparoscopic and robotic pyeloplasty (ICD-9 55.87) in the United States from 2003 to 2010. Univariate and multivariate statistics were used to evaluate perioperative outcomes, complications and costs for the competing surgical approaches. Propensity weighting was used to minimize selection bias. Sampling weights were used to yield a nationally representative sample.
  
  
  RESULTS
  A decrease in open pyeloplasty and an increase in minimally invasive pyeloplasty were observed. All procedures had low complication rates. Compared to open pyeloplasty, laparoscopic and robotic pyeloplasty had longer median operative times (240 minutes, p <0.0001 and 270 minutes, p <0.0001, respectively). There was no difference in median length of stay. Median total cost was lower among patients undergoing open vs robotic pyeloplasty ($7,221 vs $10,780, p <0.001). This cost difference was largely attributable to robotic supply costs.
  
  
  CONCLUSIONS
  During the study period open pyeloplasty made up a declining majority of cases. Use of laparoscopic pyeloplasty plateaued, while robotic pyeloplasty increased. Operative time was longer for minimally invasive pyeloplasty, while length of stay was equivalent across all procedures. A higher cost associated with robotic pyeloplasty was driven by operating room use and robotic equipment costs, which nullified low room and board cost. This study reflects an adoption period for robotic pyeloplasty. With time, perioperative outcomes and cost may improve.
authors: Division of Urologic Surgery, and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: bvarda@partners.org.
authors: Briony K
authors: BK
authors: Varda
authors: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors: Emilie K
authors: EK
authors: Johnson
authors: Pediatric and Adolescent Urology, Inc., Akron, Ohio.
authors: Curtis
authors: C
authors: Clark
authors: Department of Urology, School of Medicine, Stanford University, Stanford, California.
authors: Benjamin I
authors: BI
authors: Chung
authors: Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
authors: Caleb P
authors: CP
authors: Nelson
authors: Division of Urologic Surgery, and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Steven L
authors: SL
authors: Chang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D009392:Nephrectomy / Q000191:economics* / Q000379:methods*; D012371:Robotics / Q000191:economics*; D016896:Treatment Outcome; D014481:United States; D014517:Ureteral Obstruction / Q000191:economics* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics / Q000379:methods
keywords: kidney pelvis; laparoscopy; minimally invasive; robotics; surgical procedures; ureteral obstruction