PMID- 34015455
OWN - NLM
STAT- MEDLINE
DCOM- 20211007
LR  - 20220716
IS  - 1879-1190 (Electronic)
IS  - 1072-7515 (Print)
IS  - 1072-7515 (Linking)
VI  - 233
IP  - 1
DP  - 2021 Jul
TI  - State-Level Examination of Clinical Outcomes and Costs for Robotic and 
      Laparoscopic Approach to Diaphragmatic Hernia Repair.
PG  - 9-19.e2
LID - S1072-7515(21)00360-4 [pii]
LID - 10.1016/j.jamcollsurg.2021.05.003 [doi]
AB  - BACKGROUND: Published studies evaluating the effect of robotic assistance on 
      clinical outcomes and costs of care in diaphragmatic hernia repair (DHR) have 
      been limited. STUDY DESIGN: The Healthcare Cost and Utilization Project State 
      Inpatient and State Ambulatory Surgery and Services Databases for Florida were 
      queried to identify patients undergoing transabdominal DHR between 2011 and 2018 
      and associated inpatient and outpatient encounters within 12 months after the 
      index operation. Patients undergoing robotic DHR were 1:1:1 propensity 
      score-matched for age, sex, race, Elixhauser comorbidity score, case priority, 
      payer, and facility volume with patients undergoing open and laparoscopic DHR. 
      RESULTS: There were 5,962 patients (67.3%) who underwent laparoscopic DHR, 1,520 
      (17.2%) who underwent open DHR, and 1,376 (15.5%) who underwent robotic DHR. On 
      comparison of matched cohorts, median index length of stay (3 days; interquartile 
      range [IQR] 2 to 5 days vs 2 days; IQR 1 to 4 days; p < 0.001) and index 
      hospitalization costs ($17,236; IQR $13,231 to $22,183 vs $12,087; IQR $8,881 to 
      $17,439; p < 0.001) for robotic DHR were greater than for laparoscopic DHR. 
      Median length of stay for open DHR (6 days; IQR 4 to 10 days) was longer than 
      that for both laparoscopic and robotic DHR. Median index hospitalization costs 
      for open DHR ($16,470; IQR $11,152 to $23,768) were greater than those for 
      laparoscopic DHR, but less than those for robotic DHR. There were no significant 
      differences between cohorts in the overall rate of post-index care. CONCLUSIONS: 
      Laparoscopic DHR is the most cost-effective approach to DHR. Robotic assistance 
      provides clinical outcomes comparable with laparoscopic DHR, but is associated 
      with increased index cost.
CI  - Copyright (c) 2021 American College of Surgeons. All rights reserved.
FAU - Kulshrestha, Sujay
AU  - Kulshrestha S
AD  - Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and 
      Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL. 
      Electronic address: sujay.kulshrestha@lumc.edu.
FAU - Janjua, Haroon M
AU  - Janjua HM
AD  - Department of Surgery, University of South Florida, Tampa, FL; OnetoMap 
      Analytics, University of South Florida, Tampa, FL.
FAU - Bunn, Corinne
AU  - Bunn C
AD  - Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and 
      Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL.
FAU - Rogers, Michael
AU  - Rogers M
AD  - Department of Surgery, University of South Florida, Tampa, FL.
FAU - DuCoin, Christopher
AU  - DuCoin C
AD  - Department of Surgery, University of South Florida, Tampa, FL.
FAU - Abdelsattar, Zaid M
AU  - Abdelsattar ZM
AD  - Depatment of Thoracic and Cardiovascular Surgery, Loyola University Medical 
      Center, Maywood, IL; Edward Hines, Jr Veterans Administration Hospital, Hines, 
      IL.
FAU - Luchette, Fred A
AU  - Luchette FA
AD  - Department of Surgery, Loyola University Medical Center, Maywood, IL; Edward 
      Hines, Jr Veterans Administration Hospital, Hines, IL.
FAU - Kuo, Paul C
AU  - Kuo PC
AD  - Department of Surgery, University of South Florida, Tampa, FL; OnetoMap 
      Analytics, University of South Florida, Tampa, FL.
FAU - Baker, Marshall S
AU  - Baker MS
AD  - Department of Surgery, Loyola University Medical Center, Maywood, IL; Edward 
      Hines, Jr Veterans Administration Hospital, Hines, IL.
LA  - eng
GR  - T32 AA013527/AA/NIAAA NIH HHS/United States
GR  - T32 GM008750/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20210517
PL  - United States
TA  - J Am Coll Surg
JT  - Journal of the American College of Surgeons
JID - 9431305
SB  - IM
CIN - J Am Coll Surg. 2021 Jul;233(1):19-20. PMID: 34175060
MH  - Cost-Benefit Analysis
MH  - Databases, Factual/economics/statistics & numerical data
MH  - Florida/epidemiology
MH  - Hernia, Diaphragmatic/epidemiology/*surgery
MH  - Hospitalization/economics/statistics & numerical data
MH  - Humans
MH  - *Laparoscopy/economics/statistics & numerical data
MH  - Length of Stay/economics/statistics & numerical data
MH  - *Robotic Surgical Procedures/economics/statistics & numerical data
MH  - Treatment Outcome
PMC - PMC8238911
MID - NIHMS1703491
EDAT- 2021/05/21 06:00
MHDA- 2021/10/08 06:00
PMCR- 2022/07/01
CRDT- 2021/05/20 20:14
PHST- 2021/01/07 00:00 [received]
PHST- 2021/04/30 00:00 [revised]
PHST- 2021/05/03 00:00 [accepted]
PHST- 2021/05/21 06:00 [pubmed]
PHST- 2021/10/08 06:00 [medline]
PHST- 2021/05/20 20:14 [entrez]
PHST- 2022/07/01 00:00 [pmc-release]
AID - S1072-7515(21)00360-4 [pii]
AID - 10.1016/j.jamcollsurg.2021.05.003 [doi]
PST - ppublish
SO  - J Am Coll Surg. 2021 Jul;233(1):9-19.e2. doi: 10.1016/j.jamcollsurg.2021.05.003. 
      Epub 2021 May 17.