Adoption of Robotic Surgery for Common Surgical Procedures, (169 404 patients in 73 hospitals): The use of robotic surgery for all general surgery procedures increased from 1.8% to 15.1%, 2012-2018

Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. Kyle H. Sheetz, Jake Claflin, Justin B. Dimick. JAMA Netw Open. 2020;3(1):e1918911. January 10, 2020, doi:10.1001/jamanetworkopen.2019.18911

Key Points
Question  Given concerns that robotic surgery is increasing for common surgical procedures with limited evidence and unclear clinical benefit, how is the use of robotic surgery changing over time?

Findings  In this cohort study of 169 404 patients in 73 hospitals, the use of robotic surgery for all general surgery procedures increased from 1.8% to 15.1% from 2012 to 2018. Hospitals that launched robotic surgery programs had a broad and immediate increase in the use of robotic surgery, which was associated with a decrease in traditional laparoscopic minimally invasive surgery.

Meaning  These findings highlight a need to continually monitor the adoption of robotic surgery to ensure that enthusiasm for new technology does not outpace the evidence needed to use it in the most effective clinical contexts.

Abstract
Importance  Increasing use of robotic surgery for common surgical procedures with limited evidence and unclear clinical benefit is raising concern. Analyses of population-based trends in practice and how hospitals’ acquisition of robotic surgical technologies is associated with their use are limited.

Objective  To characterize trends in the use of robotic surgery for common surgical procedures.

Design, Setting, and Participants  This cohort study used clinical registry data from Michigan from January 1, 2012, through June 30, 2018. Trends were characterized in the use of robotic surgery for common procedures for which traditional laparoscopic minimally invasive surgery was already considered a safe and effective approach for most surgeons when clinically feasible. A multigroup interrupted time series analysis was performed to determine how procedural approaches (open, laparoscopic, and robotic) change after hospitals launch a robotic surgery program. Data were analyzed from March 1 through April 19, 2019.

Exposures  Initiation of robotic surgery.

Main Outcomes and Measures  Procedure approach (ie, robotic, open, or laparoscopic).

Results  The study cohort included 169 404 patients (mean [SD] age, 55.4 [16.9] years; 90 595 women [53.5%]) at 73 hospitals. The use of robotic surgery increased from 1.8% in 2012 to 15.1% in 2018 (8.4-fold increase; slope, 2.1% per year; 95% CI, 1.9%-2.3%). For certain procedures, the magnitude of the increase was greater; for example, for inguinal hernia repair, the use of robotic surgery increased from 0.7% to 28.8% (41.1-fold change; slope, 5.4% per year; 95% CI, 5.1%-5.7%). The use of robotic surgery increased 8.8% in the first 4 years after hospitals began performing robotic surgery (2.8% per year; 95% CI, 2.7%-2.9%). This trend was associated with a decrease in laparoscopic surgery from 53.2% to 51.3% (difference, −1.9%; 95% CI, −2.2% to −1.6%). Before adopting robotic surgery, hospitals’ use of laparoscopic surgery increased 1.3% per year. After adopting robotic surgery, the use of laparoscopic surgery declined 0.3% (difference in trends, −1.6%; 95% CI, −1.7% to −1.5%).

Conclusions and Relevance  These results suggest that robotic surgery has continued to diffuse across a broad range of common surgical procedures. Hospitals that launched robotic surgery programs had a broad and immediate increase in the use of robotic surgery, which was associated with a decrease in traditional laparoscopic minimally invasive surgery.