Profitable Robotic Surgery – Real or Science Fiction?

Robotic surgery has been hailed as the “future of surgery” and is rapidly being adopted by hospitals across the country. Many believe that robots will increase surgical efficiency and improve outcomes, ultimately saving money and making cases more profitable. Hospitals with robots advertise them heavily, hoping to attract patients and surgeons alike. But are the extremely high upfront costs of purchasing a robot worth it? We analyzed 113,539 cases from 266 hospitals in our Surgical Profitability Compass Cohort to see if robots live up to the hype.

Robotic Surgery Still Not the Norm

Although more hospitals are purchasing robots, the vast majority of procedures are still conducted using open or laparoscopic approaches. In our sample, robotic gynecological procedures were the most common type, but still only constituted 12% of total gynecological procedures. Urological procedures were the second most common, but were a greater percentage (27%).    

Mixed Results

Of the cases we reviewed, robotic surgery generally did not translate to a shorter length of stay, case duration, or turnover time. In fact, for some procedures, robotic cases were actually less efficient. For example, for laparoscopic cholecystectomy procedures, robotic cases had a median length of stay of four days, compared to three days for laparoscopic and open procedures, and a case duration of 106 minutes (patient in to patient out) compared to 87 minutes for open cases and 88 for laparoscopic cases. Overall, our data did not support the idea that robots increase surgical efficiency.

The financial impact of using a robot was more mixed. Direct supply costs per case were higher for robotic procedures in all of the procedures we analyzed, in some cases by thousands of dollars. However, surprisingly, robotic surgery was still more profitable for some procedures, including certain types of hysterectomies. For others, especially those we classified as “emerging” (those for which a robot had been used in fewer than 150 total cases), robotic surgery had a substantially lower net profit. For example, for single internal mammary-coronary artery bypass surgeries, open procedures had a net profit of $33,439, more than $14,000 more than robotic procedures at $19,385.

Are your surgeon's getting the surgical performance data they need? 

If You've Got One, Use It Sparingly

If you have already purchased a robot, you’ll want to be extremely strategic about your usage. Our data indicate that profitability increases with volume – the more frequently a procedure is performed, the more likely it is to be efficient and profitable. Therefore, you should limit the number of robotic procedures you perform and restrict robot usage to a small group of credentialed, high-volume surgeons.

In addition, you should try to tackle the extremely high supply costs for robotic procedures. For the surgeons you allow to use the robot, you need to regularly update preference cards and standardize surgical trays. You may also want to consider publishing surgeon’s supply costs to foster a healthy sense of competition.

If You Don’t, Is It Worth It?

If you have not yet purchased a robot, you may want to seriously consider whether or not a robot will actually benefit your hospital. While we did see that using a robot increased profitability for some high-volume procedures, we did not see any real gains in efficiency. In addition the difference in profit between open, laparoscopic, and robotic procedures was not that dramatic, and open and laparoscopic procedures do not require the huge upfront investment that robots do. If you spend one to two million on a robot, how many procedures would you have to perform to see any return on investment?

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