Original Research The Financial Impact of Robotic Technology for Partial and Radical Nephrectomy Max Kates, MD, Mark W. Ball, MD, Hiten D. Patel, MD, Michael A. Gorin, MD, Phillip M. Pierorazio, MD, and Mohamad E. Allaf, MD Abstract Purpose: We sought to evaluate the financial impact of robotic technology for partial nephrectomy (PN) and radical nephrectomy (RN) in the state of Maryland. Methods: The Maryland Health Services Cost Review Commission (HSCRC) documents all acute care hospital charges data. This database was queried for patients who underwent laparoscopic or robot-assisted RN and PN from 2008 to 2012. Total hospital charge, subcharge, and length of stay (LOS) were analyzed separately for RN and PN. Results: Overall, 2834 patients were identified. Of those, 282 were laparoscopic PN (LPN), 1078 robot-assisted PN (RPN), 1098 laparoscopic RN (LRN), and 376 robot-assisted RN (RRN). For PN, the total hospital charge was $19,062 for LPN and $18,255 for RPN (P = 0.138), with a charge savings of $807 per case in favor of robotics. For RN, the total hospital charge was $23,391 for RRN and $18,280 for LRN (P = 0.004), with a charge premium of $5111 for robotic cases. LOS was shorter for RPN compared with LPN (2.51 vs 2.99 days, P < 0.0001) and for RRN compared with LRN (3.52 vs 3.98, P = 0.0498). Conclusions: RPN is associated with lower hospital charges than LPN, while RRN is associated with higher hospital charges than LRN. Savings for RPN are driven by decreased room and board charge, while the premium for RRN is driven by higher operating room and supply charges. Because RRN use is increasing, the financial implications of RRN use for routine cases warrants further study. Introduction D uring the past 10 years, robotic technology has in- creasingly been used for kidney surgery. Laparosco- pic and robotic approaches are associated with smaller, less morbid incisions and shorter hospital stays. Many surgeons have come to prefer robotic technology because of its im- proved ergonomics, shorter learning curve, and enhanced three- dimensional visualization compared with laparoscopy. 1 As a result, robot-assisted partial nephrectomy (RPN) has now overtaken laparoscopic partial nephrectomy (LPN) as the most commonly performed nephron-sparing surgery. 2 In addition, while laparoscopic radical nephrectomy (LRN) continues to be performed with regularity, the use of robot-assisted radical nephrectomy (RRN) has grown in recent years. 3 Despite the increasing use of robotic kidney surgery, out- comes remain mixed when compared with traditional lapa- roscopy. The economic impact of robotics has been evaluated in single-institution studies, but remains unclear. 4,5 For kid- ney surgery, few studies have compared direct costs of ro- botic surgery with alternative approaches, and in the prostate literature, the cost effectiveness of robotic technology con- tinues to be debated. 6,7 In the current healthcare climate, cost studies are essential to justify widespread adoption of new technologies. In this study, we evaluated the financial impact of robotic technology for partial nephrectomy (PN) and radical ne- phrectomy (RN) in a prospective, multi-institutional state registry. Methods The Maryland Health Services Cost Review Commission (HSCRC) has collected clinical, demographic, and billing data from all inpatient discharges in 51 Maryland hospitals. 8 Mandated by the state legislature in the 1970s, these dis- charge data are used to regulate hospital rates throughout the state. The data are deidentified and available to the public and have been used previously by our group and others to analyze surgical cost and outcomes. 2,9,10 After obtaining Institutional Review Board approval, the HSCRC database was queried for patients who underwent The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland. JOURNAL OF ENDOUROLOGY Volume XX, Number XX, XXXX 2014 ª Mary Ann Liebert, Inc. Pp. ---–--- DOI: 10.1089/end.2014.0559 1