Department of Surgery, USF Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA.
Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
J Robot Surg. 2022 Aug;16(4):833-839. doi: 10.1007/s11701-021-01304-6. Epub 2021 Sep 13.
Robotic Inguinal Hernia repair has been associated with higher costs but shorter length of stay. Robotic surgery is an appealing option for patients undergoing elective hernia surgery however given the high startup, maintenance and operating costs, the adoption of robotic technology may not guarantee increased profitability. Our hypothesis is that the introduction of robotic technology increases the overall surgical volume of inguinal hernia repairs within a hospital as compared to non-robotic hospitals. The 2010-2018 Florida Agency for Health Care Administration Ambulatory Patient data were queried for Open, Laparoscopic and Robotic inguinal hernia repairs using ICD9, ICD10 and CPT codes. Using a difference in difference (DID) technique, we determined the difference of the total hernia volume of robotic hospitals pre- and post-adoption of robotic technology. In addition, selected hospitals which were early adopters of robotic technology were compared to with their surrounding non-robotic competitor hospitals. Incident Rate Ratios-IRR, from the difference in difference analysis determined the significance of robotic technology. Hospital and patient demographic data were evaluated, and chi square test were used to determine statistical significance. p < 0.05 was considered significant. There were a total of 258,785 inguinal hernia repairs (5774 Robotic, 88,265 Laparoscopic and 164,746 Open) performed at 398 hospitals, 94 of which had robotic capabilities. Of all the procedure types, around 90% were primary inguinal hernia repairs. The majority of patients in this cohort were white non-Hispanic or Latino males (85%, 84%, 92%), age group 51-70 (46%), holding commercial health insurance (43%) and belonged to the lowest Charlson comorbidity index level (82%). Facility types designation for almost all robotic hospitals was hospital (99%), whereas 65% of non-robotic hospitals were ambulatory surgery centers and all other hospitals. Robotic hospitals experienced a 9.5% increase in total volume of inguinal hernia repairs after introduction of robotic technology (Incident Rate Ratios-IRR 1.095, p value < 0.0001). A significant increase in total hernia volume was observed for the early adopter hospitals with the IRR(s) ranging 1.20-2.51 (all p values < 0.0001), implying that adoption of robotic technology can in fact lead to very significant increase in total hernia volume for a hospital. The introduction of robotic technology leads to an increase in the overall volume of inguinal hernia repairs performed at a given hospital. To further evaluate the impact of robotic technology and significance of this methodology, additional work is underway using additional procedures and data from other states.
机器人腹股沟疝修补术与较高的成本相关，但住院时间较短。机器人手术是接受择期疝手术患者的一个有吸引力的选择，然而，由于启动、维护和运营成本高，采用机器人技术可能并不能保证盈利能力的提高。我们的假设是，与非机器人医院相比，机器人技术的引入会增加医院内腹股沟疝修补术的总体手术量。使用 ICD9、ICD10 和 CPT 代码，对 2010 年至 2018 年佛罗里达州卫生保健管理局门诊患者数据进行了开放式、腹腔镜和机器人腹股沟疝修复的查询。使用差异（DID）技术，我们确定了机器人技术采用前后机器人医院总疝量的差异。此外，还比较了早期采用机器人技术的选定医院与其周围的非机器人竞争医院。差异分析中的发病率比值（IRR）确定了机器人技术的意义。评估了医院和患者的人口统计学数据，并使用卡方检验确定了统计学意义。p < 0.05 被认为具有统计学意义。共有 258785 例腹股沟疝修复术（5774 例机器人，88265 例腹腔镜和 164746 例开放式）在 398 家医院进行，其中 94 家医院具备机器人能力。在所有手术类型中，约 90%为原发性腹股沟疝修复术。该队列中的大多数患者为白人非西班牙裔或拉丁裔男性（85%、84%、92%），年龄在 51-70 岁（46%），持有商业健康保险（43%），属于最低 Charlson 合并症指数水平（82%）。几乎所有机器人医院的设施类型指定都是医院（99%），而非机器人医院中有 65%是日间手术中心，其余的都是其他医院。引入机器人技术后，机器人医院的腹股沟疝总修复量增加了 9.5%（发病率比值-IRR 为 1.095，p 值 < 0.0001）。早期采用者医院的总疝量显著增加，IRR 范围为 1.20-2.51（所有 p 值均 < 0.0001），这意味着采用机器人技术实际上可以使医院的总疝量显著增加。机器人技术的引入导致了特定医院进行的总体腹股沟疝修复量的增加。为了进一步评估机器人技术的影响和这种方法的意义，正在使用来自其他州的其他程序和数据进行额外的工作。
