title: Robot-assisted vs open adrenalectomy: evaluation of cost-effectiveness and peri-operative outcome.
abstract: OBJECTIVE
  To compare robot-assisted laparoscopic adrenalectomy (RALA) and open adrenalectomy (OA) with regard to intra-operative complications, peri-operative outcome and cost effectiveness.
  
  
  METHODS
  Functional and statistical data from patients who underwent OA or RALA between 2001 and 2015 were prospectively recorded including intra- and postoperative outcomes. Data on per-day costs from current census reports (€540/day and €1 145/day for normal and intermediate care [IMC]) were also used to evaluate treatment costs. Additional costs for RALA were assumed at €2288 as reported in the current literature. Patients were matched by American Society of Anesthesiologists score, age, side of surgery and gender for comparison of OA and RALA. A total of 28 matched pairs were analysed with regard to patient characteristics, peri-operative outcomes and cost-effectiveness. Statistical significance of outcome variables was determined using Student's t-test and Pearson's chi-squared test.
  
  
  RESULTS
  As a result of the matching process, patient groups did not differ in their main characteristics. Length of hospital stay was shorter for RALA than for OA (11.1 ± 4.8 vs 6.8 ± 1.2 days; P < 0.01) as was IMC treatment (2.3 ± 1.7 vs 1.2 ± 0.4 days; P < 0.01). The mean operating time was longer for RALA (128.5 ± 46.5 vs 102.2 ± 44.5 min; P = 0.03), but the last 10 RALA procedures (mean: 97.1 ± 35.2 min) were similar to OA. The rate of complications was similar in the two groups. Estimated costs were €8 627.5 for OA and €7 334 for RALA.
  
  
  CONCLUSIONS
  The study showed that RALA was safe and cost-effective compared with OA. Increasing experience leads to similar operating times, putting high-volume centres at an advantage.
authors.affiliation: Department of Urology and Paediatric Urology, Saarland University Medical Centre, Homburg, Germany.
authors.forename: Kai Alexander
authors.initials: KA
authors.lastname: Probst
authors.affiliation: Department of Urology and Paediatric Urology, Saarland University Medical Centre, Homburg, Germany.
authors.forename: Carsten-Henning
authors.initials: CH
authors.lastname: Ohlmann
authors.affiliation: Department of Urology and Paediatric Urology, Saarland University Medical Centre, Homburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Saar
authors.affiliation: Department of Urology and Paediatric Urology, Saarland University Medical Centre, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.affiliation: Department of Urology and Paediatric Urology, Saarland University Medical Centre, Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stöeckle
authors.affiliation: Department of Urology and Paediatric Urology, Saarland University Medical Centre, Homburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Janssen
mesh_terms: D000315:Adrenalectomy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics*; D016896:Treatment Outcome
keywords: adrenalectomy; endocrinology; intra-operative complications; peri-operative outcome; robot-assisted surgery; treatment costs