The Untold Economic Advantages of Robotic
SurgeryRobert Poston, MD
Chairman, Cardiothoracic SurgerySt Francis Medical Center, Trenton, NJ
Conventional Wisdom: Robotic surgery is more expensive than open or laparoscopic surgery
LIMITATIONS OF LITERATURE: ACCOUNTING FOR DYNAMIC COSTS
• Standard accounting practice for determining ROI• Spread out fixed costs of capital over the
timeframe in which revenue is generated• Hospitals allocate fixed costs to the
responsible department
Decision to Purchase a Robot Decision to Use a Robot
• Not standard practice for calculating costs/profitability of specific procedures
Allocate fixed robot costs
only to robotic cases
Costs/case increased
for robotics
More cases done open/ laparoscopc
Decreased volume of
robotic cases
Sunk cost fallacy
LIMITATIONS OF LITERATURE: AMORTIZATION OF CAPITAL EQUIPMENT
AVAILABLE SAFEGUARDS
Totally endoscopic (TECAB)
Minithoracotomy
safety frontier
Unsafe
Safe
Robotic Heart Surgery Tradeoffs
LESS
INVA
SIVE
NES
S
Sternotomy• Standardized, automated• Prerequisites understood• Easy access to safety net (CPB)
LESS
INVA
SIVE
NES
S
AVAILABLE SAFEGUARDS
Safe
Totally endoscopic (TECAB)
Minithoracotomy
safety frontier
Unsafe
Safe
Robotic Heart Surgery Tradeoffs
Sternotomy• Standardized, automated• Prerequisites understood• Easy access to safety net (CPB)
safety frontier Unsafe
Safe
Culture of safety- “no blame” approach- psychological safety- collaboration
LESS
INVA
SIVE
NES
S
AVAILABLE SAFEGUARDS
Expectations
Time
Performance
Low
High
Low
High
Rapid Improvements
1st case …Nth case
Expectations-reality gap
Robotic programintroduced
Trial and error
Status quo
Life Cycle of Robotic Surgery
Conclusions
1. Control for costs that are dynamic or sunk2. Focus on the opportunity costs3. Tie value into the “big picture”
Rational economic analysis of robotics: