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Robotic-assisted repair of complex ventral hernia: can it pay off?

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Abstract

Pressure on health care providers is growing due to capping of remuneration for medical services in most Western European countries. We wanted to investigate, if robotic-assisted ventral hernia repair is reasonable from an economic point of view in our setting. Patients undergoing open or robotic-assisted repair for complex abdominal wall hernia using a Transversus Abdominis Release (TAR) between September 2017 and January 2019 were included. Procedure-related costs were calculated exact to the minute and cost unit accounting for the postoperative in-patient stay was done. Abdominal wall reconstruction using the TAR-technique was done in a total of 26 (10 female) patients via an open (n = 10) or robotic-assisted (n = 16) approach. No significant difference was seen in regard to age, BMI and ASA scores between subgroups. Time for operation was longer (253.5 vs 211.5 min; p = 0.0322), while postoperative hospital stay was shorter for patients operated with a robotic-assisted approach (4.5 vs 12.5 days; p < 0.005). Procedure-related costs were 2.7-fold higher when a robotic-assisted reconstruction was done (EUR 5397 vs. 1989), while total costs for in-patient stay were about 60% lower (EUR 2715 vs 6663). Currently, revenues by national insurance account for a total of EUR 9577 leading to a profit of EUR 1465 and 925 for the robotic-assisted and open myofascial release, respectively. In addition, 30-day re-admission rate was in favor of the robotic-assisted approach as well (6.3% vs 20%). From an economic point of view, robotic-assisted TAR for complex ventral hernia repair is a viable option in our setting. Higher procedure-related costs are offset by a significant shorter hospital stay. The economic advantage goes along with improvement in outcome of patients.

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Authors and Affiliations

  1. Department of Surgery, St John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria

    Bernhard Dauser, Nikolaus Hartig, Mariam Vedadinejad, Florian Trummer & Friedrich Herbst

  2. Department of Gynecology, St John of God Hospital, Vienna, Austria

    Elisabeth Kirchner

  3. Vienna Medical School, Sigmund Freud University, Vienna, Austria

    Bernhard Dauser, Mariam Vedadinejad, Florian Trummer & Friedrich Herbst

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  1. Bernhard Dauser
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  2. Nikolaus Hartig
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Correspondence to Bernhard Dauser.

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Bernhard Dauser, Nikolaus Hartig, Mariam Vedadinejad, Elisabeth Kirchner, Florian Trummer, and Friedrich Herbst declare that there are no conflicts of interest.

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Dauser, B., Hartig, N., Vedadinejad, M. et al. Robotic-assisted repair of complex ventral hernia: can it pay off?. J Robotic Surg 15, 45–52 (2021). https://doi.org/10.1007/s11701-020-01078-3

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  • DOI: https://doi.org/10.1007/s11701-020-01078-3

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