Length of stay and nhi-reimbursed expenditures after robotic-assisted surgery in taiwan: a nationwide population-based study
- 1Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- 2Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- 3School of Medicine, College of Medicine, MacKay Medical University, New Taipei, Taiwan
Abstract
Population-level evidence comparing robotic-assisted surgery (RAS) with laparoscopic surgery (LS)/video-assisted thoracoscopic surgery (VATS) and open surgery (OS) across multiple procedures from a payer perspective remains limited. This study aimed to compare postoperative length of stay (LOS) and insurer-reimbursed in-hospital expenditures among RAS, LS/VATS, and OS across representative procedures following the expansion of RAS reimbursement in Taiwan. This retrospective nationwide population-based cohort study was conducted using claims data from Taiwan’s National Health Insurance Research Database. We identified adults (age ≥ 18 y) who underwent 1 of 12 representative procedures spanning thoracic, hepatobiliary-pancreatic, colorectal, urologic, and gynecologic specialties between September 1 and December 31, 2024. Surgical approaches were classified as robotic-assisted surgery (RAS), laparoscopic or video-assisted thoracoscopic surgery (LS/VATS), or open surgery (OS) using the corresponding procedure and robotic-assistance codes in the NHI claims database. The outcomes were postoperative LOS and total NHI-reimbursed in-hospital expenditures excluding special medical materials during the index hospitalization. Procedure-specific stabilized inverse probability of treatment weighting was applied to each pairwise comparison. This study included 17 549 patients. Of these patients, 2900, 9763, and 4886 underwent RAS, LS/VATS, and OS, respectively. RAS was associated with a significantly shorter postoperative LOS than LS/VATS for lung resection, colectomy, partial nephrectomy, and nephroureterectomy and with lower reimbursed expenditures for lung resection, partial pancreatectomy, nephroureterectomy, and radical prostatectomy. Compared with OS, RAS was associated with a significantly shorter postoperative LOS for selected procedures, with the largest difference noted for colectomy (8.38 vs. 14.80 d). Moreover, RAS was associated with lower reimbursed expenditures than OS for lung resection, minor hepatectomy, partial pancreatectomy, colectomy, and malignant hysterectomy. During the early period following the September 2024 expansion of NHI reimbursement for RAS in Taiwan, RAS was associated with shorter postoperative LOS for selected procedures, whereas differences in NHI-reimbursed in-hospital expenditures excluding special medical materials varied by procedure and comparator. Given the observational study design, residual confounding, and limited propensity-score overlap in several comparisons, particularly RAS versus OS, these findings should be interpreted as procedure-specific associations rather than evidence of clinical or economic superiority.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04103-z.
Related
- Adoption of robot-assisted minimally invasive surgery across surgical specialties in France: a nationwide population-based study.
- Modified dual-portal robotic-assisted thoracic surgery using a Japanese-manufactured robotic platform
- Radiation-Associated Lung Adenosquamous Carcinoma Diagnosed by Robotic-Assisted Bronchoscopy With Cone-Beam CT Guidance and Treated With Robotic Superior Segmentectomy: A Case Report
- Robotic-assisted beating heart surgery: a comprehensive review
- Comparative efficacy of uniportal and multiportal robotic-assisted thoracoscopic surgery for non-small cell lung cancer: a systematic review and meta-analysis
BibTeX
@article{chen2026length,
title = {{Length of stay and nhi-reimbursed expenditures after robotic-assisted surgery in taiwan: a nationwide population-based study}},
author = {Po-Da Chen and Ching-Hu Chung and Cheng-Yueh Lu and Te-Wei Su and Yao-Ming Wu},
journal = {Journal of Robotic Surgery},
year = {2026},
month = oct,
doi = {10.1007/s11701-026-04103-z},
url = {https://doi.org/10.1007/s11701-026-04103-z},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Length of stay and nhi-reimbursed expenditures after robotic-assisted surgery in taiwan: a nationwide population-based study
AU - Po-Da Chen
AU - Ching-Hu Chung
AU - Cheng-Yueh Lu
AU - Te-Wei Su
AU - Yao-Ming Wu
PY - 2026
DA - 2026/10/27
JO - Journal of Robotic Surgery
DO - 10.1007/s11701-026-04103-z
UR - https://doi.org/10.1007/s11701-026-04103-z
AB - Population-level evidence comparing robotic-assisted surgery (RAS) with laparoscopic surgery (LS)/video-assisted thoracoscopic surgery (VATS) and open surgery (OS) across multiple procedures from a payer perspective remains limited. This study aimed to compare postoperative length of stay (LOS) and insurer-reimbursed in-hospital expenditures among RAS, LS/VATS, and OS across representative procedures following the expansion of RAS reimbursement in Taiwan. This retrospective nationwide population-based cohort study was conducted using claims data from Taiwan’s National Health Insurance Research Database. We identified adults (age ≥ 18 y) who underwent 1 of 12 representative procedures spanning thoracic, hepatobiliary-pancreatic, colorectal, urologic, and gynecologic specialties between September 1 and December 31, 2024. Surgical approaches were classified as robotic-assisted surgery (RAS), laparoscopic or video-assisted thoracoscopic surgery (LS/VATS), or open surgery (OS) using the corresponding procedure and robotic-assistance codes in the NHI claims database. The outcomes were postoperative LOS and total NHI-reimbursed in-hospital expenditures excluding special medical materials during the index hospitalization. Procedure-specific stabilized inverse probability of treatment weighting was applied to each pairwise comparison. This study included 17 549 patients. Of these patients, 2900, 9763, and 4886 underwent RAS, LS/VATS, and OS, respectively. RAS was associated with a significantly shorter postoperative LOS than LS/VATS for lung resection, colectomy, partial nephrectomy, and nephroureterectomy and with lower reimbursed expenditures for lung resection, partial pancreatectomy, nephroureterectomy, and radical prostatectomy. Compared with OS, RAS was associated with a significantly shorter postoperative LOS for selected procedures, with the largest difference noted for colectomy (8.38 vs. 14.80 d). Moreover, RAS was associated with lower reimbursed expenditures than OS for lung resection, minor hepatectomy, partial pancreatectomy, colectomy, and malignant hysterectomy. During the early period following the September 2024 expansion of NHI reimbursement for RAS in Taiwan, RAS was associated with shorter postoperative LOS for selected procedures, whereas differences in NHI-reimbursed in-hospital expenditures excluding special medical materials varied by procedure and comparator. Given the observational study design, residual confounding, and limited propensity-score overlap in several comparisons, particularly RAS versus OS, these findings should be interpreted as procedure-specific associations rather than evidence of clinical or economic superiority. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04103-z.
SN - 1863-2483
SN - 1863-2491
ER -