OBJECTIVES

In 2018, twelve robotic assisted surgical procedures received coverage under the national health insurance system in Japan. Among these procedures, gastrectomy is particularly important in East Asia where rates of gastric cancer are significantly higher than in the West. This study compared average length of stay (ALOS), transfusion rates and healthcare resource utilization (HRU) among robotic-assisted, conventional, and open gastrectomy overall and within distal, total, and proximal gastrectomy.

METHODS

Patients who underwent gastrectomies performed 2008 to 2018 were identified using receipt codes in the Medical Data Vision (MDV), a hospital-based claims database. Receipt codes were further used to identify blood transfusions, and HRU costs were summarized for all health claim charges during the patient’s hospital visit for a gastrectomy procedure.

RESULTS

Study authors identified 86 robotic-assisted gastrectomies compared to 23,201 laparoscopic and 36,805 open. Despite the vast difference in numbers, this study is meaningful as it serves as early indicator of differences in HRU and presents an opportunity to study an emerging procedure. Robotic compared to laparoscopy ALOS (SD) was 14.1 (7.12) vs. 17.9 (11.68), p<0.0001, and robotic compared to open was 14.1 (7.12) vs. 24.9 (16.03), p<0.0001. The authors observed a similar trend in ALOS across type of gastrectomy. In total gastrectomy, robotic ALOS was approximately 6 and 11 days shorter than laparoscopic and open, respectively. Robotic and laparoscopic (2.3% vs. 7.1%) transfusion rates were not significant (p=0.1286). However, robotic and open rates (2.33% vs. 28.56%) were significant (p<0.0001). There were significantly (p<0.0001) lower charges for laparoscopy than open, ¥1,973,752 (¥868,734) vs ¥1,736,966 (¥600,152). Charges for robotic were slightly lower than laparoscopic, ¥1,714,069 (¥528,326) vs ¥1,736,966 (¥600,152), but were not significant (p=0.7239).

CONCLUSIONS

Introduction of minimally invasive (robotic and laparoscopic) gastrectomy may have reduced HRU in Japan by leading to shorter lengths of stay than open gastrectomy.