The paper was presented at the annual meeting of the American Association of Gynecologic Laparoscopists by a group from the Florida Hospital in Orlando.
The headline, “Robotic Hysterectomy Cuts Blood Loss in Obese,” is certainly catchy. Let’s look deeper. The study was a retrospective comparison of 111 patients who had robotic hysterectomy to 152 who had standard laparoscopic hysterectomy. All women had BMIs greater than 30. The robotic group had an average estimated blood loss of 85 cc versus 210 cc in the laparoscopic group. Sounds good, right? However, the difference in blood loss of only 125 cc [about 1/4 of a unit of blood] is hardly clinically significant. This was confirmed by the study’s own data. Average postop hemoglobin levels were 13.1 g/dL and 12.5 g/dL respectively.
There were also fewer conversions to open surgery in the robotic group. Duration of both types of operation was similar but does not take into account the lengthy set-up time, often as long as one hour, that robotic surgery entails.
The problem with any retrospective study is that confounding factors may not have been accounted for. It is likely that the women chosen for the robotic surgery were highly selected for suitability. We know nothing about either group’s co-morbidities, previous operations, uterine pathologies [e.g., cancer or not] or other possible factors influencing outcomes.
Here is the most interesting part of the report. The lead author said, “The robotic hysterectomy does … offer lower rates of conversion to laparotomy but does cause higher facility and total charges, as well as higher reimbursement rates.” The mean total hospital charge for robotic hysterectomy was $44,700 versus $25,557, a statistically significant difference. The average charge for the robotic instruments was $8,322 compared to $3,762 for standard laparoscopy equipment, also a significant difference. In response to a question about why there was such a disparity, the lead author said: “The charges are likely to recoup the cost of the robot purchase. We have multiple robots … four at our main institution and several others at other sites.”
The reimbursement actually received for robotic hysterectomy was $19,000 and for standard laparoscopic, a mere $$8,000.
I congratulate the authors for their candor [though no doubt inadvertent] in sharing the financial data and the reasons why robotic surgery is more costly. I am gobsmacked* at the differential in charges and reimbursement for the two types of hysterectomy and that the secret would be so openly shared.
I guess someone has to help the hospital “recoup the cost of the robot purchase.” But I wonder why third party payers are shelling out almost two-and-a half times more money for a procedure that has not been proven more effective than standard laparoscopic surgery?
And you wonder why health care costs are skyrocketing?
*gobsmacked-UK slang for astonished