Abstract
The use of robotic technology in general surgery continues to increase, though its utility for emergency general surgery remains under-studied. This study explores the current trends in patient outcomes and cost of robotic emergency general surgery (REGS). The Florida Agency for Healthcare Administration database (2018–2020) was queried for adult patients undergoing intra-abdominal emergency general surgery within 24 h of admission and linked to CMS Cost Reports/Hospital Compare, American Hospital Association, and Rand Corporation Hospital datasets. Patients from the four most common REGS procedures were propensity matched to laparoscopic equivalents for hospital cost analysis. A telephone survey was performed with the top 10 REGS hospitals to identify key qualities for successful REGS programs. 181 hospitals (119 REGS, 62 non-REGS) performed 60,733 emergency surgeries. Six-percent were REGS. The most common REGS were cholecystectomy, appendectomy, inguinal and ventral hernia repairs. Before and after propensity matching, total cost for these four procedures were significantly higher than their laparoscopic equivalents, which was due to higher surgical cost as the non-operative costs did not differ. There were no differences in mortality, individual complications, or length of stay for most of the four procedures. REGS volume significantly increased each year. The survey found that 8/10 hospitals have robotic-trained staff available 24/7. Although REGS volume is increasing in Florida, cost remains significantly higher than laparoscopy. Given higher costs and lack of significantly improved outcomes, further study should be undertaken to better inform which specific patient populations would benefit from REGS.
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Data Availability
The data used in this study is subject to Data Use Agreements (DUA). In particular the Florida Agency for Healthcare Administration Data requires a DUA - please email contactus@ahca.myflorida.com for more information. Data utilized that does not require a DUA is available from the authors upon request.
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Funding
Dr. Kuo recently received a research grant from Intuitive Surgery, Inc., though the grant was not in place at the time we performed this study and in no way influenced nor sponsored this study. All other authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EG, HJ, TH, MR, and PK The first draft of the manuscript was written by EG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Grimsley, E.A., Janjua, H.M., Herron, T. et al. Patient outcomes and cost in robotic emergency general surgery. J Robotic Surg 17, 2937–2944 (2023). https://doi.org/10.1007/s11701-023-01739-z
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DOI: https://doi.org/10.1007/s11701-023-01739-z