C. L. Stewart1, S. Dumitra1, C. Nota1, P. H. Ituarte1, L. Melstrom1, Y. Woo1, G. Singh1, Y. Fong1, H. Nathan2, S. G. Warner1 1City Of Hope National Medical Center,Surgical Oncology/Surgery,Duarte, CA, USA 2University Of Michigan,Hepatobiliary Surgery/Surgery,Ann Arbor, MI, USA
Introduction: Although the use of robotics in general surgery is increasing in the United States, hospital and patient-level factors driving adoption are sparsely studied. We hypothesized that general surgeons are more likely to use a robotic surgical platform at hospitals where more urologic and gynecologic robotic surgeries are performed, suggesting that hospital related factors are important for platform choice.
Methods: We queried the Nationwide Inpatient Sample from 2010-2013 for patients who underwent surgery on the gallbladder, pancreas, stomach, spleen, colon, or rectum (general surgery), the prostate or kidney (urologic surgery), and ovaries or uterus (gynecologic surgery). Operations were classified as robotic if any ICD-9-CM robotic procedure code was used. Hospitals were grouped into quartiles according to percentage of total volume of urologic or gynecologic surgeries that were performed robotically (0-20%, 21-40%, 41-60%, >60%). Multivariable logistic regression modeling was used to determine independent variables associated with robotic surgery.
Results: Survey-weighted results represented 461,368 (47.6%) open, 479,783 (49.5%) laparoscopic, and 27,620 (2.6%) robotic general surgical operations. For general surgery patients, robotics use increased with each subsequent year studied (5.4% by 2013), and was most commonly performed for rectal surgery (7.0%), on patients with private insurance (3.2%) and higher household income (3.3%, all p<0.001). Robotic operations were also more frequently performed at urban teaching hospitals (3.4%), compared to rural and non-teaching hospitals (p<0.001). The odds of a general surgery patient receiving a robotic operation increased directly with increased use in urologic and gynecologic surgery at the hospital (Figure 1, *p<0.001). General surgery patients treated at a top quartile hospital for robotic urologic surgery had 4 times greater odds of receiving a robotic operation compared to an open or laparoscopic operation (confidence interval 3.0-5.4, p<0.001). This finding was independent of study year, surgical site, insurance type, household income, and hospital type, and also persisted when only comparing laparoscopic to robotic procedures.
Conclusions: The use of robotics in general surgery is directly and independently related to its use in urologic and gynecologic surgery at a hospital. Our study suggests that hospital factors strongly influence robotic use in general surgery.
