Priscila R Armijo, MD1, Spyridon Pagkratis, MD1, Eugene Boilesen2, Tiffany N Tanner, MD1, Dmitry Oleynikov, MD, FACS1. 1University of Nebraska Medical Center, 2University of Nebraska College of Public Health
Introduction: The number of robotic-assisted surgeries (RAS) has increased rapidly in a wide variety of procedures, such as hysterectomy and prostatectomy where the technology enabled convectional open procedures to become minimally invasive. In general surgery, utilization of laparoscopy (LAP) has been growing for years but now there is a rapid increase in RAS. The aim of this study is to evaluate national trends in RAS utilization in common general surgeries, the proportion of open, LAP and RAS utilization and their cost.
Methods: This is a multi-center, retrospective study from October 2008 to September 2015. The UHC clinical database resource manager (CDB/RM) was queried using ICD-9 procedure codes for colectomy, cholecystectomy, inguinal hernia repair (IHR) and bariatric surgeries, either open, LAP or RAS approaches. Trends in utilization were evaluated between quarters (Q4 2008 to Q3 2015) and direct cost of all four surgeries was compared within minimally invasive approaches. Data analysis was conducted using IBM SPSS v.23.0.0 using linear-by-linear association and non-parametric tests when appropriate, with α=0.05.
Results: Between Oct/2008 and Sep/2015, a total of 857,468 patients underwent colectomy (Open: N=141,995, LAP: N=72,072, RAS: N=2,586), cholecystectomy (Open: N=78,968, LAP: N=171,800, RAS: N=1,905), IHR (Open: N=22,182, LAP: N=3,157, RAS: N=1,305) and bariatric procedures (Open: N=24,195, LAP: N=118,528, RAS: N=4,708). A significant decrease in utilization of open techniques was seen in colectomy (71.8% to 61.9%), cholecystectomy (35.7% to 27.1%) and bariatric (20.1% to 10.1%); whereas both LAP and RAS utilization increased (p<0.001). A significant positive trend in RAS was seen in all four procedures: colectomy (0.4% to 8.0%), cholecystectomy (0.2% to 1.8%), IHR (19.9% to 29.4%) and bariatric (0.6% to 5.4%), compared to a decrease in its LAP counterpart utilization (p<0.001) (Figure 1). Mean direct cost of surgery was significantly higher for open ($14,364), followed by RAS ($11,376) and least costly was LAP ($7,945), p<0.001.
Conclusion: While robotic technology in other surgical subspecialties has been seen as enabling open procedures to be converted to MIS, in general surgery this trend was not observed. On the contrary, trends analysis revealed a significant growth of RAS utilization compared to LAP and not a conversion from open procedures. RAS were costlier than their laparoscopic counterpart for all four procedures. The benefits of rapid robot adoption and the forces that are driving these must be examined against a backdrop of burdening an already expensive healthcare system.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79125
Program Number: S071
Presentation Session: Robotics
Presentation Type: Podium