Last Resort from Nursing Shortage? Comparative Cost Analysis of Open vs. Robot-Assisted Partial Nephrectomies with a Focus on the Costs of Nursing Care

SIMPLE SUMMARY: As robotic surgery is less invasive and patients recover faster compared to open surgery, the postoperative nursing effort should be lower. However, this potential cost savings mechanism for the otherwise more expensive robotic surgery has not been investigated yet. Therefore, we compared 198 robotic and 61 open partial kidney resections performed within two years at an experienced center. Indeed, the median total nursing time and daily nursing effort were significantly lower after robotic surgery, which resulted in mean savings of EUR 186.48 in nursing costs per robotic surgery. However, this cost savings mechanism alone did not amortize the overall increased costs of the robotic system. ABSTRACT: Despite perioperative advantages, robot-assisted surgery is associated with high costs. However, the lower morbidity of robotic surgery could lead to a lower nursing workload and cost savings. In this comparative cost analysis of open retroperitoneal versus robot-assisted transperitoneal partial nephrectomies (PN), these possible cost savings, including other cost factors, were quantified. Therefore, patient, tumor characteristics, and surgical results of all PN within two years at a tertiary referral center were retrospectively analyzed. The nursing effort was quantified by the local nursing staff regulation and INPULS(®) intensive care and performance-recording system. Out of 259 procedures, 76.4% were performed robotically. After propensity score matching, the median total nursing time (2407.8 vs. 1126.8 min, p < 0.001) and daily nursing effort (245.7 vs. 222.6 min, p = 0.025) were significantly lower after robotic surgery. This resulted in mean savings of EUR 186.48 in nursing costs per robotic case, in addition to savings of EUR 61.76 due to less frequent administrations of erythrocyte concentrates. These savings did not amortize the higher material costs for the robotic system, causing additional expenses of EUR 1311.98 per case. To conclude, the nursing effort after a robotic partial nephrectomy was significantly lower compared to open surgery; however, this previously unnoticed savings mechanism alone could not amortize the overall increased costs.