Use, Cost, Complications, and Mortality of Robotic versus Nonrobotic General Surgery Procedures Based on a Nationwide Database

Abstract

Since its introduction in 1997, robotic surgery has overcome many limitations, including setup costs and surgeon training. The use of robotics in general surgery remains unknown. This study evaluates robotic-assisted procedures in general surgery by comparing characteristics with its nonrobotic (laparoscopic and open) counterparts. Weighted Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (2008, 2009) were used to identify the top 12 procedures for robotic general surgery. Robotic cases were identified by Current Procedural Terminology codes 17.41 and 17.42. Procedures were grouped: esophagogastric, colorectal, adrenalectomy, lysis of adhesion, and cholecystectomy. Analyses were descriptive, t tests, χ2s, and logistic regression. Charges and length of stay were adjusted for gender, age, race, payer, hospital bed size, hospital location, hospital region, median household income, Charlson score, and procedure type. There were 1,389,235 (97.4%) nonrobotic and 37,270 (2.6%) robotic cases. Robotic cases increased from 0.8 per cent (2008) to 4.3 per cent (2009, P < 0.001). In all subgroups, robotic surgery had significantly shorter lengths of stay (4.9 days) than open surgery (6.1 days) and lower charges (median $30,540) than laparoscopic ($34,537) and open ($46,704) surgery. Fewer complications were seen in robotic-assisted colorectal, adrenalectomy and lysis of adhesion; however, robotic cholecystectomy and esophagogastric procedures had higher complications than nonrobotic surgery ( P < 0.05). Overall robotic surgery had a lower mortality rate (0.097%) than nonrobotic surgeries per 10,000 procedures (laparoscopic 0.48%, open 0.92%; P < 0.001). The cost of robotic surgery is generally considered a prohibitive factor. In the present study, when overall cost was considered, including length of stay, robotic surgery appeared to be cost-effective and as safe as nonrobotic surgery except in cholecystectomy and esophagogastric procedures. Further study is needed to fully understand the long-term implications of this new technology.

Robot‐assisted oesophageal and gastric surgery for benign disease: antireflux operations and Heller's myotomy

“…Robotic oesophagogastric surgery had a higher morbidity (9.4%) and mortality (0.3%) rate than laparoscopic surgery (7.1% and 0.17%, respectively, all P < 0.05). Cost was slightly higher for robotic oesophagogastric surgery (median $US42 358 versus laparoscopic $US40 441) …”

“…Salman et al . reported on 37 270 robotic general surgery operations using discharge data from the Nationwide Inpatient Sample (NIS) for the January 2008 to December 2009 period . The NIS is a 20% stratified sample of US community hospital discharges collected by the US government's Agency for Healthcare Research and Quality.…”

“…Hospitals presumably wish to maximize use of the devices because of the high purchase and maintenance costs. In the United States, 31 867 general surgery operations (∼4.3% of all general surgery operations) were performed with robotic assistance in 2009 and robotic cholecystectomy is already being performed for uncomplicated elective cases in Australia. We conducted this review to investigate whether robot assistance provides significant advantages or disadvantages for benign foregut surgery, excluding bariatric surgery.…”

Robot‐assisted gastrectomy and oesophagectomy for cancer

“…The future of robotic surgery will also include improvements in haptic feedback and vision, and easier port placement and docking mechanisms. Even with the current robot, a study that used Nationwide Inpatient Sample data, representing 20% of US community hospital discharges, showed that the use of robotic general surgery in the operations selected increased from 0.8% in 2008 to 4.3% in 2009 . This study also reported that, overall, robot‐assisted general surgery was more cost‐effective than open or laparoscopic general surgery if hospitalization costs were included, and robotic general surgery was associated with lower morbidity and mortality.…”

“…This study also reported that, overall, robot‐assisted general surgery was more cost‐effective than open or laparoscopic general surgery if hospitalization costs were included, and robotic general surgery was associated with lower morbidity and mortality. This large study is subject to multiple potential confounders, including the likelihood that robotic surgery was typically used in less acute and less complicated procedures …”