Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs

Priscila R. Armijo, Spyridon Pagkratis, Eugene Boilesen, Tiffany Tanner, Dmitry Oleynikov

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2106-2113
Number of pages8
JournalSurgical endoscopy
Volume32
Issue number4
DOIs
StatePublished - Apr 1 2018

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Robotics
Laparoscopy
Costs and Cost Analysis
Growth
Colectomy
Cholecystectomy
Ventral Hernia
Bariatrics
Bariatric Surgery
Inguinal Hernia
Herniorrhaphy
International Classification of Diseases
Surgeons
Databases
Retrospective Studies
Technology
Delivery of Health Care

Keywords

  • Bariatric surgery
  • Cost
  • Hernia
  • Minimally invasive surgery
  • Robotic surgery
  • Trends

ASJC Scopus subject areas

  • Surgery

Cite this

Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion : a study of trends and costs. / Armijo, Priscila R.; Pagkratis, Spyridon; Boilesen, Eugene; Tanner, Tiffany; Oleynikov, Dmitry.

In: Surgical endoscopy, Vol. 32, No. 4, 01.04.2018, p. 2106-2113.

Research output: Contribution to journalArticle

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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.",
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T1 - Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion

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AU - Pagkratis, Spyridon

AU - Boilesen, Eugene

AU - Tanner, Tiffany

AU - Oleynikov, Dmitry

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N2 - 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.

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