title: The impact of robotic cholecystectomy on private practice in a community teaching hospital.
abstract: BACKGROUND
  Recently, through aggressive marketing, robotic cholecystectomy has been gaining popularity. The purpose of this study was to evaluate the impact of this technology on private practice and hospital cost and volume.
  
  
  METHODS
  From November 2012 to April 2014, all elective cholecystectomies were evaluated for procedure type, operative time (OR), insurance type and payment, hospital length of stay, and volume. Data were analyzed using the Chi-square test, Student t test and the Mann-Whitney U test.
  
  
  RESULTS
  Of 338 patients, 246 had complete financial records. Of these patients, 84.1% (207) patients were female with mean age of 45.4 ± 17.1 years. Patients were divided into 2 groups; group 1: 220(89.4%) patients had laparoscopic cholecystectomy (LC) and group 2: 26(10.6%) patients had robotic cholecystectomy (RC). The mean direct cost was higher in the robotic group $2,704.08 ± 308.40 vs $1,712.51 ± 379.50; P < .0001. The median gross margin; however, was not statically different (RC: $1,593.00 (Interquartile range $3,936) vs LC: $1,726.00 (Interquartile range $1,480); P = .85). Both case time and OR were higher in the robotic group; case time (RC: 121 ± 15.4 vs LC: 98.4 ± 27.5 minutes, P < .0001); OR (RC: 86.6 ± 14.3 vs LC: 63.9 ± 25.9 minutes, P < .0001). There was no appreciable change over time in either surgeon or hospital volume.
  
  
  CONCLUSIONS
  There was a statistically significant increase in direct cost in RC vs. LC but not in margin. There was no impact in private practice on the number of cases being done robotically, nor there was an increase in hospital volume. This analysis did not include the purchase cost or maintenance of the robot.
authors.affiliation: St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48326, USA. Electronic address: eastsidesurgical@aol.com.
authors.forename: A
authors.initials: A
authors.lastname: Hawasli
authors.affiliation: St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48326, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sahly
authors.affiliation: St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48326, USA.
authors.forename: A
authors.initials: A
authors.lastname: Meguid
authors.affiliation: St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48326, USA.
authors.forename: E
authors.initials: E
authors.lastname: Edhayan
authors.affiliation: St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48326, USA.
authors.forename: C
authors.initials: C
authors.lastname: Guiao
authors.affiliation: St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48326, USA.
authors.forename: S
authors.initials: S
authors.lastname: Szpunar
mesh_terms: D002763:Cholecystectomy / Q000191:economics / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics; D016896:Treatment Outcome
keywords: Cholecystectomy; Cost; Laparoscopic; Robotic; Volume