Robotic-assisted outcomes are not tied to surgeon volume and experience

There are little data regarding whether hospital and surgeon factors affect outcomes following robotic-assisted surgery (RAS). The purpose of this study was to investigate whether any such factor was associated with hospital length of stay (HLOS) and complications following common RAS procedures in the State of New York.

Following IRB approval, The New York Statewide Planning and Research Cooperative System administrative dataset was used to identify eight common RAS procedures through ICD-9 codes: cholecystectomy, colectomy, Roux-en-Y gastric bypass, sleeve gastrectomy, esophageal fundoplication, pancreatectomy, splenectomy, and gastrectomy between 2008 and 2012. Physician factors evaluated included time since graduation, fellowship status, and number of procedures performed; hospital-level factors included urban versus rural setting, teaching status, hospital size, and the presence of a fellowship. All these factors were further evaluated in multivariable regression models to evaluate for effect on overall complication and HLOS after adjusting for covariates such as patients’ characteristics and comorbidities.

There were 1670 patients who underwent RAS with average HLOS of 4.433 days and overall complication rate of 18.8 %. Univariate analysis showed that patients of physicians having fellowship training tended to have higher rate of complication—22.82 versus 13.49 % (P = 0.0055), but these were also sicker patients. In addition, physicians with higher number of procedures had lower complications (P = 0.0138). However, these two factors were not significant after controlling for other covariates. Neither physician- nor hospital-related factors were significantly related to HLOS with or without adjusting for other covariates.

Robotic assistance may eliminate the differences between hospitals and physicians.