Kathleen Coakley, DO, Steven A Groene, MD, Blair Wormer, MD, Tanushree Prasad, MA, Amy E Lincourt, PhD, MBA, Vedra Augenstein, MD, B. Todd Heniford, MD, Paul D Colavita, MD. Carolinas HealthCare System
Introduction: The purpose of this study was to evaluate nationwide trends in robotic-assisted General Surgery procedures (RAGS).
Methods: The Nationwide Inpatient Sample, which captures approximately 20% of all US inpatient admissions, was queried from October 2008 (the inception of the robotic ICD-9-CM code) to December 2013 (the last available information) for patients undergoing elective abdominal RAGS.
Results: From October 2008-December 2013, 676,354 elective, abdominal, minimally invasive General Surgery operations were performed, of which 9,874 (1.5%) were RAGS. From 2008 to 2013 the incidence of RAGS significantly increased each year (p<0.001). In 2008, RAGS comprised 0.33% of elective abdominal general surgery cases; by 2013, the prevalence had risen to 3.3%.
From 2008-2013, 9,874 RAGS were performed, of which 39.5% were in 2013. When comparing RAGS of 2013 with earlier experience (2008-2009), there was no change in age or gender of the patients. Those who underwent RAGS in 2013 had more overall comorbidities (4.2±2.6 vs 3.7±2.3; p<0.001): a higher prevalence of liver disease (4.3% vs 2.4%; p=0.02). Complication rates (8.9% vs 9.5%; p=0.5) and mortality rates (0.10% vs 0.15%, p=0.7) did not change. Length of stay lessened (3.4±2.7 vs 3.7±2.6; p=0.0005). Total costs for RAGS procedures increased over the same 5 years ($65,601±$40612 vs $54,609±$33,244; p<0.001).
In 2013, zip codes with median household incomes ≥$64,000 had the highest percentage of RAGS (27.0%), however the percentage performed in zip codes with median household incomes <$38,000 increased (20.9% vs 14.5%; p=0.0001) and fewer RAGS were performed in patients with private insurance (52.0%vs 57.8%; p=0.01) when compared to 2008-2009. Regionally, the South had the highest proportion of RAGS and the largest regional growth (38.6%vs 30.7%; p<0.001). While the vast majority of RAGS procedures were done in urban teaching settings during both time periods, there was a significant shift to more rural hospitals in 2013 (3.18% vs 1.03%; p=0.04). A lesser percentage of RAGS were performed in teaching hospitals (65.4% vs 79.9%; p<0.001) and more commonly performed in medium-sized hospitals (26.4% vs 10.0%; p<0.001).
Conclusions: This nationwide study evidences RAGS increasing incidence across the country. RAGS numbers have increased, as have costs, while complications and mortality have remained the same. Robotics in general surgery remains regionalized to urban teaching centers in higher income areas, though there is an increasing trend for RAGS to be performed in smaller, non-teaching hospitals, and in less affluent locations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79029
Program Number: P688
Presentation Session: Poster (Non CME)
Presentation Type: Poster