Single institutional cost analysis of 325 robotic, laparoscopic, and open partial nephrectomies

Objective: To compare costs associated with partial nephrectomy (PN) using robotic, laparoscopic (LPN), and open (OPN) approaches. Methods: An Investigational Review Board-approved prospectively maintained database was reviewed for 325 patients who underwent PN at our institution from January 2009 to December 2010. Costs for each surgical technique were itemized, including hospitalization, operating room (OR), anesthesia, medication, laboratory and pathology, professional fees, and blood bank. Continuous variables were analyzed with Kruskal-Wallis and Wilcoxon tests, and categoric variables were analyzed with χ² and Fisher exact tests. Results: Median costs of RPN were higher than LPN ($632, P =.005), but not significantly higher than OPN ($313, P =.14). The major cause of this difference was OR instrumentation and supplies. OR costs for LPN and OPN were equivalent (P =.11). The cost associated with anesthesia was significantly lower for RPN and LPN than for OPN (P =.002). RPN and LPN had lower hospitalization costs than OPN (P <.0001), which was largely due to the shorter hospital stay (P <.0001) and lower laboratory cost (P <.0001). Pharmacy costs and blood bank costs were not significantly different among groups (P =.09 and P =.48, respectively). Conclusion: RPN had higher operating room costs than LPN and OPN, primarily due to instrumentation and supplies. This higher cost was offset by decreased cost of hospitalization in compared with the OPN group. Modification of practices aimed at lowering RPN instrumentation and supply costs may enable cost equivalence.