• Arjun Verma, Joseph Hadaya, Shannon Richardson, Amulya Vadlakonda, Ramin Ramezani, Sha'Shonda Revels, and Peyman Benharash.
• Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
• Ann. Surg. 2023 Aug 1; 278 (2): e377e381e377-e381.

ObjectiveTo characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs.BackgroundThe high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking.MethodsAdults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions.ResultsAn estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P <0.001), as well as significantly reduced length of stay (-0.8 d, P <0.001) and costs (-$3900, P <0.001).ConclusionsIncreasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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