Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.
Department of Surgery, University of California, UCLA Surg-Gen, Box 956904, 72-239 CHS, Los Angeles, CA, 90095-6904, USA.
Surg Endosc. 2018 Mar;32(3):1405-1413. doi: 10.1007/s00464-017-5822-4. Epub 2017 Aug 25.
Robotic-assisted procedures were frequently found to have similar outcomes and indications to their laparoscopic counterparts, yet significant variation existed in the acceptance of robotic-assisted technology between surgical specialties and procedures. We performed a retrospective cohort study investigating factors associated with the adoption of robotic assistance across the United States from 2008 to 2013.
Using the Nationwide Inpatient Sample database, patient- and hospital-level variables were examined for differential distribution between robotic-assisted and conventional laparoscopic procedures. Multilevel logistic regression models were constructed to identify independent factors associated with robotic adoption. Furthermore, cases were stratified by procedure and specialty before being ranked according to proportion of robotic-assistance adoption. Correlation was examined between robotic-assistance adoption and relative outcome in comparison with conventional laparoscopic procedures.
The national robotic case volume doubled over the five-year period while a gradual decline in laparoscopic case volume was observed, resulting in an increase in the proportion of procedures performed with robotic assistance from 6.8 to 17%. Patients receiving robotic procedures were more likely to be younger, males, white, privately insured, more affluent, and with less comorbidities. These differences have been decreasing over the study period. The three specialties with the highest proportion of robotic-assisted laparoscopic procedures were urology (34.1%), gynecology (11.0%), and endocrine surgery (9.4%). However, no significant association existed between the frequency of robotic-assistance usage and relative outcome statistics such as mortality, charge, or length of stay.
The variation in robotic-assistance adoption between specialties and procedures could not be attributable to clinical outcomes alone. Cultural readiness toward adopting new technology within specialty and target anatomic areas appear to be major determining factors influencing its adoption.
机器人辅助手术与腹腔镜手术相比，具有相似的结果和适应证，但在外科专业和手术之间，机器人辅助技术的接受程度存在显著差异。我们进行了一项回顾性队列研究，调查了 2008 年至 2013 年期间美国机器人辅助技术应用的相关因素。
利用国家住院患者样本数据库，对患者和医院水平的变量进行了检查，以确定机器人辅助和常规腹腔镜手术之间的差异分布。建立多水平逻辑回归模型，以确定与机器人应用相关的独立因素。此外，根据程序和专业对病例进行分层，然后根据机器人辅助应用的比例进行排序。比较机器人辅助手术与常规腹腔镜手术的相对结果，以检查相关性。
在五年期间，全国机器人手术量增加了一倍，而腹腔镜手术量逐渐减少，因此机器人辅助手术的比例从 6.8%增加到 17%。接受机器人手术的患者更年轻、男性、白人、私人保险、更富裕、合并症更少。这些差异在研究期间逐渐减少。机器人辅助腹腔镜手术比例最高的三个专业是泌尿科（34.1%）、妇科（11.0%）和内分泌外科（9.4%）。然而，机器人辅助使用率与死亡率、费用或住院时间等相对结果统计数据之间没有显著关联。
专业和手术之间机器人辅助应用的差异不能仅归因于临床结果。在专业和目标解剖区域内采用新技术的文化准备似乎是影响其应用的主要决定因素。
