# Factors associated with increased costs in robotic gastric bypass surgery: Australian healthcare system perspective

## TL;DR

This study identifies factors that increase the costs of robotic gastric bypass surgery in the Australian healthcare system, using data from the US.

## Contribution

The study applies US-based data to the Australian healthcare system to identify specific cost drivers for robotic gastric bypass surgery.

## Key findings

- Using laparoscopic bedside staplers significantly reduces inpatient costs and operative-room time compared to robotic staplers.
- Patient age, gender, race, and hospital location are significant factors affecting the cost of robotic gastric bypass surgery.
- Laparoscopic bedside staplers provide equivalent clinical outcomes to other stapler types while reducing costs.

## Abstract

This study aimed to understand the cost drivers of robotic Roux-en-Y gastric bypass (rRYGB) with specific application to the Australian healthcare system. US-based PINC AI™ Healthcare Data (1/1/2021–12/31/2022) were used to extract patients who underwent elective rRYGB procedures. We included patients who used single-type staplers in each case, had non-zero costs, and non-missing key variables. Factors including patient and hospital characteristics, type of staplers used [laparoscopic bedside staplers (LBS), other unspecified bedside staplers (OBS), and robotic staplers (RS)] were evaluated. Multivariable general linear models were used to identify cost drivers. Sensitivity analysis was done by the bootstrapping method. The results were then applied to Australian healthcare system model. In this US cohort, 7606 rRYGB discharges were studied, including 18.9% LBS, 8.7% OBS, and 72.4% RS cases. The factors associated with increased costs included type of staplers, patients older than 54, male, non-Hispanic White, diagnosis of obesity, comorbidity >  = 3, severity of illness, hospitals in the Northeast, located in rural area, with large size (> = 500 beds), lower surgeon annual volume, and procedures done in 2022. After adjusting for other factors, compared to OBS and RS, rRYGB used the LBS significantly reduced total inpatient cost by $2,220 ± $432 (Mean difference ± Standard deviation) and $2,119 ± $181, and significantly reduced operative-room time by 43.3 ± 3.9 and 41.4 ± 2.1 min, respectively. Meanwhile, LBS has equivalent outcomes, including blood transfusion, bleeding, anastomotic leak, and ICU visits, compared to other types of staplers. RS and OBS were essential factors associated with increased costs in patients treated with rRYGB compared to LBS.

The online version contains supplementary material available at 10.1007/s11701-025-02483-2.