Radical prostatectomies increased in hospitals acquiring robotic technology

Makarov DV. Med Care. 2011;doi:10.1097/MLR.0b013e318202adb9.

Hospitals that acquired a surgical robot performed nearly 30 more radical prostatectomies annually than they performed before acquiring the technology, according to study results.

Researchers from several sites in the US conducted a retrospective cohort study to determine associations between surgical robot acquisition and changes in radical prostatectomy rates at 554 nonfederal, community hospitals between 2001 and 2005.

By 2005, 51% of hospital referral regions in the investigation had at least one hospital with a surgical robot. Overall, 12% of hospitals had acquired at least one robot by 2005.

Adjusted, clustered analysis results that generalized estimating equations indicated that regions that had more hospitals with robots had larger increases in radical prostatectomy rates than regions acquiring no robots.

Regions with nine, four, three, two, one or zero robot-owning hospitals had mean (95% CI) total regional radical prostatectomy changes of 414.9, 189.6, 106.6, 14.7, –11.3, and –41.2, respectively, the researchers wrote.

The number of radical prostatectomies increased by a mean of 29.1 annually in hospitals that acquired the technology, whereas in hospitals without a robot, the mean change was –4.8 (P<.0001).

“Policymakers must recognize the intimate association between technology diffusion and procedure utilization when approving costly new medical devices with unproven benefit,” the researchers wrote.

There were 71 hospital referral regions under investigation, including those in Arizona, Florida, Maryland, North Carolina, New York, New Jersey and Washington. Data were collected from the Healthcare Cost and Utilization Project’s State Inpatient Databases, 2001 and 2005. These data were combined with those from the American Hospital Association Annual Survey Database, 2005 edition.

Hospitals were evaluated for the change in the number of radical prostatectomies before 2001 and after 2005, when the surgical robot had been disseminated.

Results indicated a decrease in aggregate radical prostatectomies from 14,801 to 14,420 during the study period, suggesting that “regional adoption of the surgical robot represented either supply-induced demand in local markets or the attraction of patients seeking robot surgery residing in regions without robots to those regions with an abundance of robots,” the researchers said.

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