Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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S20-12 (P)
COMPARISON OF COST AND COMPLICATIONS IN OPEN VERSUS ROBOTIC
URETERAL REIMPLANTATION IN AMERICAN CHILDREN'S HOSPITALS
Benjamin WHITTAM1, William BENNETT 2, Alison KEENAN1, Konrad SZYMANSKI1, Aaron CARROLL3, Richard RINK1 and
Mark CAIN1
1) Riley Hospital for Children at Indiana University Health, Pediatric Urology, Indianapolis, USA - 2) Riley Hospital for
Children at Indiana University Health, Pediatric Gastroenterology, Indianapolis, USA - 3) Riley Hospital for Children at
Indiana University Health, Indiana Children's Health Services Research, Indianapolis, USA
PURPOSE
Pediatric robotic-assisted laparoscopic ureteral reimplantation (RALUR) may have advantages over open ureteral
reimplant (OUR), but most analyses have shown robotic approaches to be substantially more expensive and a increased
complication rate with RALUR. We sought to investigate a large national cohort of OUR to compare to RALUR to assess
cost and outcomes.
MATERIAL AND METHODS
We used the PHIS (Pediatric Health Information System) database to query all pediatric ureteral reimplants performed
from 2004-2013 in 44 large, tertiary American children's hospitals. We restricted comparisons between OUR and RALUR
to children over the age of 1 year, and to institutions that regularly employed robotic techniques.. We performed
multivariate analysis using linear regression to compare OUR versus RALUR procedures in relation to multiple outcomes:
length of stay, rate ofcomplications, and cost.
RESULTS
When we compared OUR versus RALUR in the 18 PHIS hospitals that commonly performed robotic cases, we identified
464 RALUR and 11,471 OUR. The age distribution was similar. Robotic cases had shorter mean length of stay (1.52 days
for RALUR, 2.41 for OUR) and similar rates of surgical complications (3.9% for RALUR, 3.9% for OUR). Robotic cases
were more expensive (median cost of US$13648 for RALUR, US$7750 for OUR). Operating room charges and anesthesia
charges
accounted for the majority of the cost difference.
CONCLUSIONS
RALUR is more expensive, but has a similar rate of complications and a significantly shorter length of stay. Charges for
OR and anesthesia time dominate the cost difference. Efforts to reduce these should be the focus of future cost-
containment efforts.