Robotic Assisted Surgery: Love It or Hate It?

Robotic assisted surgery.  You either love it or hate it.  How has a tool designed to facilitate minimally invasive surgery become so divisive among surgeons and hospital administrators?  Everyone is waiting for the definitive prospective, randomized trial that will, once and for all, determine the “truth” about robotic assisted surgery.  (I know, don’t hold your breath.)  The biggest concern is, “Is it worth the expense?”  Time will tell, but what I can say in the short-term is …… it depends.

Recently I had the opportunity to evaluate the experience of a large healthcare system’s robotics programs (unpublished).  What was interesting was that there was a correlation between a surgeon’s volume and their clinical outcomes and cost.  The greater a surgeon’s volume, the lower their complications and overall cost.  The lower a surgeon’s volume, the higher their complications and overall cost.  Probably no big surprise here.  The top 20%ile of surgeons averaged 80 cases/year and the remaining 80%ile of surgeons averaged 5 cases/year.  The top 20%ile had 26.6% lower complications and 16.9% lower cost.  This data was risk adjusted and benchmarked with the Premier database.

What was even more interesting was that there was a correlation between the structure of a facility’s robotics committee and its complications and cost.  Facilities that had a highly organized infrastructure, accountability to leadership, multidisciplinary membership and stated purpose with annual goals had lower complications and cost.  This data was also risk adjusted and benchmarked to the Premier database.  Facilities with a “formal” robotics program had 31.6% lower complications and 26.9% lower cost than programs that were more loosely structured.  Put another way, relatively unstructured programs had 46% higher complications and 37% greater cost.  While the debate continues, if you own a robot, then it is in your patient’s best interest for your program to be highly structured and your surgeons to be experienced on the robot.  It may be that where you find highly structured robotics programs and busy surgeons you may also find the “love it” group, and where you find loosely structured robotics programs and least busy surgeons you may find the “hate it” group.

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