title: Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy.
abstract: BACKGROUND
  As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost.
  
  
  METHODS
  The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis.
  
  
  RESULTS
  The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p < 0.05), SILS at $1,407 (p < 0.05), and ROBOSILS at $2,608 (p < 0.05). All patients achieved the same primary outcomes: minimally invasive gallbladder removal and same day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05).
  
  
  CONCLUSIONS
  Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal.
authors.affiliation: Department of Surgery, Saint Francis Hospital, Hartford, CT; Department of Surgery, University of Connecticut Health Center, Hartford, CT.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Newman
authors.affiliation: Department of Surgery, Saint Francis Hospital, Hartford, CT; Department of Surgery, University of Connecticut Health Center, Hartford, CT. Electronic address: aumer@stfranciscare.org.
authors.forename: Affan
authors.initials: A
authors.lastname: Umer
authors.affiliation: Department of Surgery, Saint Francis Hospital, Hartford, CT.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Bozzuto
authors.affiliation: Department of Surgery, Saint Francis Hospital, Hartford, CT.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dilungo
authors.affiliation: Department of Surgery, Saint Francis Hospital, Hartford, CT; Department of Surgery, University of Connecticut Health Center, Hartford, CT.
authors.forename: Scott
authors.initials: S
authors.lastname: Ellner
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000379:methods; D003237:Connecticut; D017558:Elective Surgical Procedures / Q000191:economics* / Q000379:methods; D005260:Female; D005705:Gallbladder Diseases / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000379:methods