The first national examination of outcomes and trends in robotic surgery in the United States

Jamie Anderson, David C. Chang, J. Kellogg Parsons, Mark A. Talamini

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

BACKGROUND: There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database. STUDY DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status. RESULTS: A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.2; p < 0.001), decreased mean LOS (-2.4 days; 95% CI, -2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $3,852 to $15,329) except coronary artery bypass grafting (-$17,318; 95% CI, -34,492 to -143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.6; p = 0.008), decreased LOS overall (-0.6 days; 95% CI, -0.7 to -0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95% CI, 0.1-0.4; p = 0.006; 0.8 days; 95% CI, 0.0-1.6; p = 0.049), and increased total charges ($1,309; 95% CI, 519-2,099; p = 0.001). CONCLUSIONS: Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures.

Original languageEnglish (US)
Pages (from-to)107-114
Number of pages8
JournalJournal of the American College of Surgeons
Volume215
Issue number1
DOIs
StatePublished - Jul 1 2012

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Robotics
Length of Stay
Laparoscopy
Mortality
Odds Ratio
Databases
Hospital Charges
International Classification of Diseases
Prostatectomy
Coronary Artery Bypass
Teaching Hospitals
Population
Comorbidity
Inpatients
Urinary Bladder
Multivariate Analysis
Kidney

ASJC Scopus subject areas

  • Surgery

Cite this

The first national examination of outcomes and trends in robotic surgery in the United States. / Anderson, Jamie; Chang, David C.; Parsons, J. Kellogg; Talamini, Mark A.

In: Journal of the American College of Surgeons, Vol. 215, No. 1, 01.07.2012, p. 107-114.

Research output: Contribution to journalArticle

Anderson, Jamie ; Chang, David C. ; Parsons, J. Kellogg ; Talamini, Mark A. / The first national examination of outcomes and trends in robotic surgery in the United States. In: Journal of the American College of Surgeons. 2012 ; Vol. 215, No. 1. pp. 107-114.
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abstract = "BACKGROUND: There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database. STUDY DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status. RESULTS: A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95{\%} CI, 0.0-0.2; p < 0.001), decreased mean LOS (-2.4 days; 95{\%} CI, -2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $3,852 to $15,329) except coronary artery bypass grafting (-$17,318; 95{\%} CI, -34,492 to -143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95{\%} CI, 0.0-0.6; p = 0.008), decreased LOS overall (-0.6 days; 95{\%} CI, -0.7 to -0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95{\%} CI, 0.1-0.4; p = 0.006; 0.8 days; 95{\%} CI, 0.0-1.6; p = 0.049), and increased total charges ($1,309; 95{\%} CI, 519-2,099; p = 0.001). CONCLUSIONS: Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures.",
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N2 - BACKGROUND: There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database. STUDY DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status. RESULTS: A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.2; p < 0.001), decreased mean LOS (-2.4 days; 95% CI, -2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $3,852 to $15,329) except coronary artery bypass grafting (-$17,318; 95% CI, -34,492 to -143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.6; p = 0.008), decreased LOS overall (-0.6 days; 95% CI, -0.7 to -0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95% CI, 0.1-0.4; p = 0.006; 0.8 days; 95% CI, 0.0-1.6; p = 0.049), and increased total charges ($1,309; 95% CI, 519-2,099; p = 0.001). CONCLUSIONS: Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures.

AB - BACKGROUND: There are few population-based data describing outcomes of robotic-assisted surgery. We compared outcomes of robotic-assisted, laparoscopic, and open surgery in a nationally representative population database. STUDY DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from October 2008 to December 2009 was performed. We identified the most common robotic procedures by ICD-9 procedure codes and grouped them into categories by procedure type. Multivariate analyses examined mortality, length of stay (LOS), and total hospital charges, adjusting for age, race, sex, Charlson comorbidity index, and teaching hospital status. RESULTS: A total of 368,239 patients were identified. On adjusted analysis, compared with open, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.2; p < 0.001), decreased mean LOS (-2.4 days; 95% CI, -2.5 to 2.3; p < 0.001), and increased mean total charges in all procedures (range $3,852 to $15,329) except coronary artery bypass grafting (-$17,318; 95% CI, -34,492 to -143; p = 0.048) and valvuloplasty (not statistically significant). Compared with laparoscopic, robotic-assisted laparoscopic surgery was associated with decreased odds of mortality (odds ratio = 0.1; 95% CI, 0.0-0.6; p = 0.008), decreased LOS overall (-0.6 days; 95% CI, -0.7 to -0.5; p < 0.001), but increased LOS in prostatectomy and other kidney/bladder procedures (0.3 days; 95% CI, 0.1-0.4; p = 0.006; 0.8 days; 95% CI, 0.0-1.6; p = 0.049), and increased total charges ($1,309; 95% CI, 519-2,099; p = 0.001). CONCLUSIONS: Data suggest that, compared with open surgery, robotic-assisted surgery results in decreased LOS and diminished likelihood of death. However, these benefits are not as apparent when comparing robotic-assisted laparoscopic with nonrobotic laparoscopic procedures.

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