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Variation in the utilization of robotic surgical operations

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Abstract

The appropriate use of the robot in surgery continues to evolve. Robotic operations (RO) are particularly advantageous for deep pelvic and retroperitoneal procedures, but the implementation of RO is unknown. We aimed to examine regional variation for the most commonly performed RO in general, gynecologic, and urologic surgery. A three-state inpatient database from 2008 to 2011 was used. Nine common robotic inpatient general, gynecologic and urologic surgery procedures were analyzed. States were divided into hospital service areas (HSAs). The percentage of RO was calculated for each operation. Hospital service areas that had < 50% or > 150% of the RO average were outliers. Hospital service areas were compared based on demographics, patterns of adoption, variation in usage, and association with population, physician and hospital density. Hysterectomies were the procedure that was performed most often robotically. Over 50% of radical prostatectomies were performed robotically. Procedures with the highest rate of RO performance were performed with the least variation. Characteristics that were significantly correlated with RO included provider and hospital density. Variation in the utilization of RO is common and differs by operation. Physician density impacts access to care and is associated with the variation in use of RO depending on procedure type. Further research is needed to understand the causes of variation and adoption of RO.

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Funding

This manuscript did not receive independent funding. State databases from California, Florida and New York were utilized for this manuscript with permission for use of data and appropriate citations provided in the reference section of the manuscript. All authors listed meet the criteria for authorship and have approved this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Jennifer H. Fieber, Chris Wirtalla & Rachel R. Kelz

  2. Department of Surgery, Temple University, 3401 North Broad Street, Philadelphia, 19140, PA, USA

    Lindsay E. Kuo

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  1. Jennifer H. Fieber
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  2. Lindsay E. Kuo
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  4. Rachel R. Kelz
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Correspondence to Jennifer H. Fieber.

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Conflict of interest

Dr. Jennifer H. Fieber, Dr. Lindsay E. Kuo, Dr. Rachel R. Kelz, and Mr. Chris Wirtalla declare that they have no conflicts of interest. A portion of material in this manuscript was previously presented in the form of a published abstract and poster presentation at the Surgical Forum of the American College of Surgeons in Boston, Massachusetts on October 22nd 2018.

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Fieber, J.H., Kuo, L.E., Wirtalla, C. et al. Variation in the utilization of robotic surgical operations. J Robotic Surg 14, 593–599 (2020). https://doi.org/10.1007/s11701-019-01003-3

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  • DOI: https://doi.org/10.1007/s11701-019-01003-3

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