Juo YY, et al. – A retrospective cohort study was performed to determine factors associated with the adoption of robotic assistance across the United States from 2008 to 2013. Observations revealed that variation in robotic–assistance adoption between specialties and procedures could not be attributable to clinical outcomes alone. Major determining factors influencing its adoption seemed to include cultural readiness toward adopting new technology within specialty and target anatomic areas.

Methods

• Researchers examined patient- and hospital-level variables for differential distribution between robotic-assisted and conventional laparoscopic procedures using the Nationwide Inpatient Sample database.
• They constructed multilevel logistic regression models to determine independent factors associated with robotic adoption.
• Furthermore, they stratified cases by procedure and specialty before being ranked according to proportion of robotic-assistance adoption.
• They examined correlation between robotic-assistance adoption and relative outcome in comparison with conventional laparoscopic procedures.

Results

• Over the five-year period, the national robotic case volume doubled while there appeared a gradual decline in laparoscopic case volume, resulting in an increase in the proportion of procedures performed with robotic assistance from 6.8 to 17%.
• Patients who were younger, males, white, privately insured, more affluent more frequently underwent robotic procedures and had less comorbidities.
• Over the study period, a decrease in these differences was observed.
• Urology (34.1%), gynecology (11.0%), and endocrine surgery (9.4%) were identified as the three specialties with the highest proportion of robotic-assisted laparoscopic procedures.
• However, there appeared no significant association between the frequency of robotic-assistance usage and relative outcome statistics such as mortality, charge, or length of stay.