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Minimally invasive surgery (MIS) is associated with decreased complication rates, length of hospital stay, and cost compared with laparotomy. Robotic-assisted surgery—a method of laparoscopy—addresses many of the limitations of standard laparoscopic instrumentation, thus leading to increased rates of MIS. We sought to assess the impact of robotics on the rates and costs of surgical approaches in morbidly obese patients with uterine cancer. Patients who underwent primary surgery at our institution for uterine cancer from 1993 to 2012 with a BMI ≥40 mg/m2 were identified. Surgical approaches were categorized as laparotomy (planned or converted), laparoscopic, robotic, or vaginal. We identified two time periods based on the evolving use of MIS at our institution: laparoscopic (1993–2007) and robotic (2008–2012). Direct costs were analyzed for cases performed from 2009 to 2012. We identified 426 eligible cases; 299 performed via laparotomy, 125 via MIS, and 2 via a vaginal approach. The rates of MIS for the laparoscopic and robotic time periods were 6 % and 57 %, respectively. The rate of MIS was 78 % in this morbidly obese cohort in 2012; 69 % were completed robotically. The median length of hospital stay was 5 days (range 2–37) for laparotomy cases and 1 day (range 0–7) for MIS cases (P

INTRODUCTION AND OBJECTIVES: In addition to promoting quality, new payment models are emerging with a mandate to control healthcare costs. On a national level, there is significant variation in the cost of major index cancer operations. Accurate cost accounting, clinician-defined metrics, risk-adjustment, and feedback of data are essential steps in using cost data for quality improvement. We sought to account for institutional direct costs incurred during radical cystectomy, identify the main cost drivers in the index hospitalization, and examine surgeon variability in the main cost drivers within the context of patient characteristics. METHODS: Direct itemized institutional cost data for 321 consecutive radical cystectomies performed by 5 de-identified surgeons was obtained. Costs were adjusted using a multiplier equal to the ratio of normalized Medicare reimbursement over institutional reported cost. Interactive web-based dashboards were created to feedback patient characteristics, outcomes, cost components, and anonymized surgeon cost comparisons. Analysis of variance was used to compare patient characteristics and cost components across surgeons. Multivariable logistic regression was used to model above average costs on surgeon and patient specific factors. RESULTS: The median adjusted total cost per case was $13009.57 (interquartile range $11254.82, $15730.53). Inpatient, anesthesia, disposable device, operating room, and physician costs accounted for the majority of the total costs incurred. Inpatient costs were not significantly different across surgeons, however maximum differences between cost means for anesthesia ($93.62, p1⁄40.0039), disposable device (energy devices, $279.48, p