The association of robotic surgical technology and hospital prostatectomy volumes: increasing market share through the adoption of technology.
ABSTRACT Despite limited and conflicting evidence for the efficacy of newly developed robotic technology for laparoscopic prostatectomy, this technology is spreading rapidly. Because the newer technology is more costly, reasons for this rapid adoption are unclear. The authors of this report sought to determine whether hospital acquisition of robotic technology was associated with volume of prostate cancer surgery.
The inpatient dataset of claims records from 2002 to 2008 and the acquisition dates of robotic technology were used to examine the rates of prostatectomy in Wisconsin hospitals. In analyses that accounted for hospital and referral region characteristics, changes in hospital prostatectomy volume were examined for their association with technology acquisition. Overall trends in the rate of prostatectomy also were examined over the study period.
In total, 10,021 prostatectomies were performed in 52 hospitals in Wisconsin's 8 health referral regions during the study period. The mean quarterly prostatectomy volume in hospitals that did not acquire the technology was 4.5 in 2002 and 3.1 in 2007/2008. In contrast, the mean quarterly prostatectomy volume in hospitals that went on to acquire robotic technology was 16.5 in 2002 and 24.8 in 2007/2008. In adjusted models, the acquisition of a robot was associated with a 114% annual increase (95% confidence interval, 62%-177% annual increase) in hospital prostatectomy volume. The average Wisconsin hospital prostatectomy volume was unchanged during 2002 through 2006 but increased by 25.6% in 2007.
Robotic technology acquisition occurred rapidly in Wisconsin hospitals, and hospitals that acquired a robot had large increases in prostatectomy volume.
Full-textDOI: · Available from: Liliana E Pezzin, Oct 13, 2014
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ABSTRACT: Background:With the increasing use of robotic surgery in the United States, the comparative effectiveness and differences in reimbursement of minimally invasive radical prostatectomy (MIRP) and open prostatectomy (ORP) in privately insured patients are unknown. Therefore, we sought to assess the differences in perioperative outcomes and hospital reimbursement in a privately insured patient population who were surgically treated for prostate cancer.Methods:Using a large private insurance database, we identified 17 610 prostate cancer patients who underwent either MIRP or ORP from 2003 to 2010. The primary outcomes were length of stay (LOS), perioperative complications, 90-day readmissions rates and hospital reimbursement. Multivariable regression analyses were used to evaluate for differences in primary outcomes across surgical approaches.Results:Overall, 8981 (51.0%) and 8629 (49.0%) surgically treated prostate cancer patients underwent MIRP and ORP, respectively. The proportion of patients undergoing MIRP markedly rose from 11.9% in 2003 to 72.5% in 2010 (P<0.001 for trend). Relative to ORP, MIRP was associated with a shorter median LOS (1.0 day vs 3.0 days; P<0.001) and lower adjusted odds ratio of perioperative complications (OR: 0.82; P<0.001). However, the 90-day readmission rates of MIRP and ORP were similar (OR: 0.99; P=0.76). MIRP provided higher adjusted mean hospital reimbursement compared with ORP (US$19 292 vs US$17 347; P<0.001).Conclusions:Among privately insured patients diagnosed with prostate cancer, robotic surgery rapidly disseminated with over 70% of patients undergoing MIRP by 2009-2010. Although MIRP was associated with shorter LOS and modestly better perioperative outcomes, hospitals received higher reimbursement for MIRP compared with ORP.Prostate Cancer and Prostatic Disease advance online publication, 14 October 2014; doi:10.1038/pcan.2014.38.Prostate Cancer and Prostatic Diseases 10/2014; 18(1). DOI:10.1038/pcan.2014.38 · 2.83 Impact Factor
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ABSTRACT: IntroductionThe rapid diffusion of the surgical robot has been controversial because of the technology's high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy.Methods:We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors.Results:In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy.Conclusions:Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care.The 35th Annual Meeting of the Society for Medical Decision Making; 10/2013
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ABSTRACT: PURPOSE OF REVIEW: With clinical guidelines recommending partial nephrectomy for small renal masses, it is essential to understand the benefits of partial nephrectomy in regards to renal function. Our objective was to review current evidence and highlight emerging issues for partial nephrectomy and renal function. RECENT FINDINGS: A recent clinical trial of partial and radical nephrectomy found minimal differences in survival or adverse renal sequelae. However, most observational studies and systematic reviews suggest that partial nephrectomy decreases the risks of adverse renal function, in particular, new-onset severe chronic kidney disease, and improves overall survival. Key features associated with long-term renal function include treatment modality (observation, ablation, surgery), ischemia type and duration, amount of healthy renal preservation, and baseline renal function. SUMMARY: Partial nephrectomy should remain the standard of care for small renal masses, if the renal tumor size and complexity are amenable to such a surgical approach. Efforts to minimize ischemia time are important for long-term renal functional recovery, and hypothermia should be considered if longer warm ischemia times are anticipated (i.e. >25 min). Although the preliminary results of zero ischemia partial nephrectomy are promising, further research is needed to determine if these surgical techniques are safely adaptable in the broader urologic community.Current opinion in urology 01/2013; 23(2). DOI:10.1097/MOU.0b013e32835d8ec1 · 2.12 Impact Factor