title: Utilization and costs associated with robotic surgery in children.
abstract: BACKGROUND
  To evaluate utilization and costs associated with robotic surgery in children.
  
  
  METHODS
  We identified patients in the Pediatric Health Information System database who underwent robotic surgery between October 2008 and December 2013. After determining the six most frequently performed surgeries in this group, we identified patients who underwent equivalent nonrobotic surgeries at the same hospitals. Equivalent surgeries were defined as open procedures for urology and laparoscopic procedures for general surgery. We examined trends in the numbers of surgeries performed and compared hospitalization costs between patients undergoing elective robotic and nonrobotic surgery for each procedure.
  
  
  RESULTS
  The number of robotic surgeries performed increased by 19.8% per year (P < 0.001). The most common robotic surgeries performed were pyeloplasty (n = 760), ureteral reimplantation (n = 351), nephrectomy (n = 145), partial nephrectomy (n = 56), gastrointestinal antireflux procedure (n = 61), and cholecystectomy (n = 46). Total increase over time was primarily driven by increases in urologic surgeries (17.4% per year, P < 0.001). Postoperative length of stay was shorter after robotic surgeries than equivalent open urologic surgeries but not equivalent laparoscopic general surgery procedures. Total hospitalization costs were higher for robotic surgeries than equivalent urologic or general surgery procedures.
  
  
  CONCLUSIONS
  Use of robotic surgery in pediatrics is increasing especially in the management of urologic conditions. Costs of robotic surgery-associated hospitalizations were higher than nonrobotic surgery-associated hospitalizations.
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.affiliation: Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herz
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Diefenbach
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: daryl.mcleod@nationwidechildrens.org.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: McLeod
mesh_terms: D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000191:economics / Q000379:methods* / Q000639:trends; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods* / Q000639:trends; D005260:Female; D018662:Fundoplication / Q000191:economics / Q000379:methods* / Q000639:trends; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D010372:Pediatrics; D065287:Robotic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D013520:Urologic Surgical Procedures / Q000191:economics / Q000379:methods* / Q000639:trends
keywords: Children; Minimally invasive surgery; Pediatric surgery; Robotic surgery; Urology