Priscila R Armijo1, Spyridon Pagkratis2, Eugene Boilesen3, Tiffany Tanner1,2, Dmitry Oleynikov4,5. 1. Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. 2. Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. 3. College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA. 4. Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. doleynik@unmc.edu. 5. Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. doleynik@unmc.edu.
Abstract
BACKGROUND: Utilization of laparoscopy (LAP) has been increasing in general surgery for years, and there is currently a rapid increase in the utilization of robotic-assisted surgeries (RAS). This study evaluates trends in the surgical approach utilized in some commonly performed surgeries, the proportion of each approach within the procedures, and the cost of these surgeries based on the surgical approach. METHODS: This is a retrospective study using the Vizient database. The database was queried using ICD-9 codes for colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric surgeries, either open, LAP, or robotically performed. Utilization trends were evaluated between quarters, over a 7-year period, and direct cost was compared between approaches. IBM SPSS v.23.0.0 was used for data analysis, with α = 0.05. RESULTS: 857,468 patients underwent colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric procedures. A significant decrease in open-approach utilization was seen in colectomy (71.8-61.9%), cholecystectomy (35.7-27.1%), and bariatric surgeries (20.1-10.1%), whereas both LAP and RAS utilization increased (p < 0.001). Significant RAS increase was seen in all five procedures: colectomy (0.4-8.0%), cholecystectomy (0.2-1.8%), IHR (19.9-29.4%), VHR (0.2-2.9%), and bariatric (0.6-5.4%), compared to a decrease in LAP (p < 0.001). Surgery cost was significantly higher for open ($14,364), followed by RAS ($11,376) and LAP ($7945), p < 0.001. CONCLUSIONS: Robotic technology is commonly viewed as enabling open procedures to be converted to minimally invasive, a trend not observed in our study. Our trends analysis revealed significant RAS utilization increase from LAP procedures and not from open procedure conversion, although specific surgeon data were not available. RAS were costlier than LAP for all five 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.
BACKGROUND: Utilization of laparoscopy (LAP) has been increasing in general surgery for years, and there is currently a rapid increase in the utilization of robotic-assisted surgeries (RAS). This study evaluates trends in the surgical approach utilized in some commonly performed surgeries, the proportion of each approach within the procedures, and the cost of these surgeries based on the surgical approach. METHODS: This is a retrospective study using the Vizient database. The database was queried using ICD-9 codes for colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric surgeries, either open, LAP, or robotically performed. Utilization trends were evaluated between quarters, over a 7-year period, and direct cost was compared between approaches. IBM SPSS v.23.0.0 was used for data analysis, with α = 0.05. RESULTS: 857,468 patients underwent colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric procedures. A significant decrease in open-approach utilization was seen in colectomy (71.8-61.9%), cholecystectomy (35.7-27.1%), and bariatric surgeries (20.1-10.1%), whereas both LAP and RAS utilization increased (p < 0.001). Significant RAS increase was seen in all five procedures: colectomy (0.4-8.0%), cholecystectomy (0.2-1.8%), IHR (19.9-29.4%), VHR (0.2-2.9%), and bariatric (0.6-5.4%), compared to a decrease in LAP (p < 0.001). Surgery cost was significantly higher for open ($14,364), followed by RAS ($11,376) and LAP ($7945), p < 0.001. CONCLUSIONS: Robotic technology is commonly viewed as enabling open procedures to be converted to minimally invasive, a trend not observed in our study. Our trends analysis revealed significant RAS utilization increase from LAP procedures and not from open procedure conversion, although specific surgeon data were not available. RAS were costlier than LAP for all five 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.
Authors: Juan C Rodríguez-Sanjuán; Marcos Gómez-Ruiz; Soledad Trugeda-Carrera; Carlos Manuel-Palazuelos; Antonio López-Useros; Manuel Gómez-Fleitas Journal: World J Gastroenterol Date: 2016-02-14 Impact factor: 5.742
Authors: Vamsi V Alli; Jie Yang; Jianjin Xu; Andrew T Bates; Aurora D Pryor; Mark A Talamini; Dana A Telem Journal: Surg Endosc Date: 2016-09-07 Impact factor: 4.584
Authors: Jamin K Addae; Faiz Gani; Sandy Y Fang; Elizabeth C Wick; Azah A Althumairi; Jonathan E Efron; Joseph K Canner; David M Euhus; Eric B Schneider Journal: J Surg Res Date: 2016-09-17 Impact factor: 2.192
Authors: Y Quijano; J Nuñez-Alfonsel; B Ielpo; V Ferri; R Caruso; H Durán; E Díaz; L Malavé; I Fabra; E Pinna; R Isernia; Á Hidalgo; E Vicente Journal: Tech Coloproctol Date: 2020-02-04 Impact factor: 3.781