A financial analysis of operating room charges for robot-assisted gynaecologic surgery: Efficiency strategies in the operating room for reducing the costs.
OBJECTIVE
To analyse the steps taking place in the operating room (OR) before the console time starts in robot-assisted gynaecologic surgery and to identify potential ways to decrease non-operative time in the OR.


METHODS
Thirteen consecutive robotic cases for benign gynaecologic disease at the Department of Obstetrics and Gynecology at University of Texas Medical Branch (UTMB) were retrospectively reviewed. The collected data included the specific terms 'Anaesthesia Done' (step 1), 'Drape Done' (step 2), and 'Trocar In' (step 3), all of which refer to the time before the actual surgery began and OR charges were evaluated as level 3, 4, and 5 for open abdominal/vaginal hysterectomy, laparoscopic hysterectomy, and robot-assisted hysterectomy, respectively.


RESULTS
The cost of the OR for 0-30 minutes and each additional 30 minutes were $3,693 and $1,488, $4,961 and $2,426, $5,513 and $2,756 in level 3, 4, and 5 surgeries, respectively. The median time for step 1 was 12.1 min (5.25-23.3), for step 2 was 19 (4.59-44) min, and for step 3 was 25.3 (16.45-45) min. The total median time until the actual operation began was 54.58 min (40-100). The total cost was $6948.7 when the charge was calculated according to level 4 and $7771.1 when the charge was calculated according to level 5.


CONCLUSIONS
Robot-assisted surgery is already 'cost-expensive' in the preparation stage of a surgical procedure during anaesthesia induction and draping of the patient because of charging levels. Every effort should be made to shorten the time and reduce the number of instruments used without compromising care. (J Turk Ger Gynecol Assoc 2014; 15: 25-9).
Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, İzmir, Turkey.
Burak
B
Zeybek
Department of Obstetrics and Gynecology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Tufan
T
Oge
Counseler, İstanbul Chamber of Commerce, İstanbul, Turkey.
Cemil Hakan
CH
Kılıç
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, USA.
Mostafa A
MA
Borahay
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, USA.
Gökhan Sami
GS
Kılıç
Cost analysis; fees; gynaecology operating rooms; robot-assisted surgery