title: Robotic Gastric Bypass Surgery in the Swiss Health Care System: Analysis of Hospital Costs and Reimbursement.
abstract: Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations.
  
  
  
  Prospectively derived administrative cost data of patients who were coded with a primary diagnosis of obesity (ICD-10 code E.66.X), a procedure of gastric bypass surgery (CHOP code 44.3), and a robotic identifier (CHOP codes 00.90.50 or 00.39) during the years 2012 to 2015 was analyzed and compared to the triggered reimbursement for this patient cohort.
  
  
  
  A total of 348 patients were identified. The mean number of diagnoses was 2.7 and the mean length of stay was 5.9 days. The overall mean cost per patients was Swiss Francs (CHF) from 2012 to 2014 that was 21,527, with a mean reimbursement of CHF 24,917. Cost of the surgery in 2015 was comparable to the previous years with CHF 22,550.0 (p = 0.6618), but reimbursement decreased significantly to CHF 20,499.0 (0.0001).
  
  
  
  The average cost for robotic gastric bypass surgery fell well below the average reimbursement within the Swiss DRG system between 2012 and 2014, and this robotic procedure was a DRG winner for that period. However, the Swiss DRG system has matured over the years with a significant decrease resulting in a deficit for robotic gastric bypass surgery in 2015. This stipulates a discussion as to how health care providers should continue offering robotic gastric bypass surgery, particularly in the light of developing clinical evidence.
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. monikahagen@aol.com.
authors.forename: Monika E
authors.initials: ME
authors.lastname: Hagen
authors.affiliation: Medical controlling, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Rohner
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Minoa K
authors.initials: MK
authors.lastname: Jung
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amirghasemi
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Jassim
authors.initials: J
authors.lastname: Fakhro
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Leo
authors.initials: L
authors.lastname: Buehler
authors.affiliation: Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000191:economics* / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D012371:Robotics; D013557:Switzerland / Q000453:epidemiology
keywords: Bariatric surgery; Cost; DRG; Gastric bypass; Robotic; Robotic surgery; da Vinci; reimbursement