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S28-5
(PP)
VALIDATED COST COMPARISON OF OPEN VERSUS ROBOTIC PEDIATRIC
PYELOPLASTY IN AMERICAN CHILDREN'S HOSPITALS
Benjamin WHITTAM
1
, Alison KEENAN
1
, Richard RINK
1
, Mark CAIN
1
and William BENNETT
2
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
PURPOSE
Robotic pediatric pyeloplasty has advantages over open techniques, but most analyses have shown robotic approaches
to be more expensive. Previous cost analyses have suffered from methodological shortcomings.
MATERIAL AND METHODS
We used PHIS (Pediatric Health Information System) database to query all pediatric pyeloplasties performed from 2004-
2013 in 44 large, tertiary American children’s hospitals. We validated this administrative database using a unique, local
clinical database at Riley Hospital for Children in Indianapolis. We restricted comparisons between open and robotic
cases to children over the age of 1 year, and to institutions that regularly employed robotic techniques. We performed
regression analysis to compare open vs. robotic procedures in relation to: length of stay, rate of complications, and
cost.
RESULTS
When PHIS data were compared to matched local patients, all but 5 were perfectly matched by medical record number,
demographics, and date of procedure. Robotic cases had shorter length of stay (2.2 v. 1.6 days, p less than 0.001),
similar surgical complications (open 4.5%, robotic 3.6%, p = 0.50), and robotic cases were more expensive by US$3991
(p less than 0.001). OR and anesthesia charges accounted for the majority of the cost difference.
CONCLUSIONS
Robotic pyeloplasty is more expensive, but has same rate of complications and significantly shorter length of stay.
Charges for OR and anesthesia time dominate the cost difference. Efforts to reduce these specific costs should be the
focus of future cost-containment efforts.