Hala Muaddi1,2, Therese A Stukel2,3, Charles de Mestral2,4,3, Avery Nathens1,2,5,3, Stephen E Pautler6, Bobby Shayegan7, Waël C Hanna8, Christopher M Schlachta9, Rodney H Breau10, Laura Hopkins11, Timothy D Jackson1, Paul J Karanicolas12,13,14,15. 1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada. 2. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 3. ICES, Toronto, Canada. 4. Division of Vascular Surgery, St. Michaels Hospital, University of Toronto, Toronto, Canada. 5. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. 6. Division of Urology, Division of Surgical Oncology, Department of Surgery, Western University, London, Canada. 7. Juravinski Cancer Centre, McMaster University, Hamilton, Canada. 8. Division of Thoracic Surgery, McMaster University, Hamilton, Canada. 9. Division of General Surgery, Department of Surgery, Western University, London, Canada. 10. Division of Urology, Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. 11. Division of Oncology, Saskatchewan Cancer Agency, Saskatoon, Canada. 12. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada. paul.karanicolas@sunnybrook.ca. 13. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. paul.karanicolas@sunnybrook.ca. 14. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. paul.karanicolas@sunnybrook.ca. 15. Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. paul.karanicolas@sunnybrook.ca.
Abstract
INTRODUCTION: Robotic surgery has integrated into the healthcare system despite limited evidence demonstrating its clinical benefit. Our objectives were (i) to describe secular trends and (ii) patient- and system-level determinants of the receipt of robotic as compared to open or laparoscopic surgery. METHODS: This population-based retrospective cohort study included adult patients who, between 2009 and 2018 in Ontario, Canada, underwent one of four commonly performed robotic procedures: radical prostatectomy, total hysterectomy, thoracic lobectomy, partial nephrectomy. Patients were categorized based on the surgical approach as robotic, open, or laparoscopic for each procedure. Multivariable regression models were used to estimate the temporal trend in robotic surgery use and associations of patient and system characteristics with the surgical approach. RESULTS: The cohort included 24,741 radical prostatectomy, 75,473 total hysterectomy, 18,252 thoracic lobectomy, and 4608 partial nephrectomy patients, of which 6.21% were robotic. After adjusting for patient and system characteristics, the rate of robotic surgery increased by 24% annually (RR 1.24, 95%CI 1.13-1.35): 13% (RR 1.13, 95%CI 1.11-1.16) for robotic radical prostatectomy, 9% (RR 1.09, 95%CI 1.05-1.13) for robotic total hysterectomy, 26% (RR 1.26, 95%CI 1.06-1.50) for thoracic lobectomy and 26% (RR 1.26, 95%CI 1.13-1.40) for partial nephrectomy. Lower comorbidity burden, earlier disease stage (among cancer cases), and early career surgeons with high case volume at a teaching hospital were consistently associated with the receipt of robotic surgery. CONCLUSION: The use of robotic surgery has increased. The study of the real-world clinical outcomes and associated costs is needed before further expanding use among additional providers and hospitals.
INTRODUCTION: Robotic surgery has integrated into the healthcare system despite limited evidence demonstrating its clinical benefit. Our objectives were (i) to describe secular trends and (ii) patient- and system-level determinants of the receipt of robotic as compared to open or laparoscopic surgery. METHODS: This population-based retrospective cohort study included adult patients who, between 2009 and 2018 in Ontario, Canada, underwent one of four commonly performed robotic procedures: radical prostatectomy, total hysterectomy, thoracic lobectomy, partial nephrectomy. Patients were categorized based on the surgical approach as robotic, open, or laparoscopic for each procedure. Multivariable regression models were used to estimate the temporal trend in robotic surgery use and associations of patient and system characteristics with the surgical approach. RESULTS: The cohort included 24,741 radical prostatectomy, 75,473 total hysterectomy, 18,252 thoracic lobectomy, and 4608 partial nephrectomy patients, of which 6.21% were robotic. After adjusting for patient and system characteristics, the rate of robotic surgery increased by 24% annually (RR 1.24, 95%CI 1.13-1.35): 13% (RR 1.13, 95%CI 1.11-1.16) for robotic radical prostatectomy, 9% (RR 1.09, 95%CI 1.05-1.13) for robotic total hysterectomy, 26% (RR 1.26, 95%CI 1.06-1.50) for thoracic lobectomy and 26% (RR 1.26, 95%CI 1.13-1.40) for partial nephrectomy. Lower comorbidity burden, earlier disease stage (among cancer cases), and early career surgeons with high case volume at a teaching hospital were consistently associated with the receipt of robotic surgery. CONCLUSION: The use of robotic surgery has increased. The study of the real-world clinical outcomes and associated costs is needed before further expanding use among additional providers and hospitals.
Authors: Leslie Levin; Ron Goeree; Mark Levine; Murray Krahn; Tony Easty; Adalstein Brown; David Henry Journal: Int J Technol Assess Health Care Date: 2011-04 Impact factor: 2.188
Authors: Hala Muaddi; Melanie El Hafid; Woo Jin Choi; Erin Lillie; Charles de Mestral; Avery Nathens; Therese A Stukel; Paul J Karanicolas Journal: Ann Surg Date: 2021-03-01 Impact factor: 12.969