Buy robots and the surgery will be done. A paper in the journal Medical Care concludes that hospitals that acquire surgical robots do more radical prostatectomies as a result (an average of 29% more per year) while those without robots actually did fewer radical prostatectomies.
Association Between Diffusion of the Surgical Robot and Radical Prostatectomy Rates
BACKGROUND: Despite its expense and controversy surrounding its benefit, the surgical robot has been widely adopted for the treatment of prostate cancer.
OBJECTIVES: To determine the relationship between surgical robot acquisition and changes in volume of radical prostatectomy (RP) at the regional and hospital levels.
RESEARCH DESIGN: Retrospective cohort study.
SUBJECTS: Men undergoing RP for prostate cancer at nonfederal, community hospitals located in the states of Arizona, Florida, Maryland, North Carolina, New York, New Jersey, and Washington.
MEASURES: Change in number of RPs at the regional and hospital levels before (2001) and after (2005) dissemination of the surgical robot.
RESULTS: Combining data from the Healthcare Cost and Utilization Project State Inpatient Databases 2001 and 2005 with the 2005 American Hospital Association Survey and publicly available data on robot acquisition, we identified 554 hospitals in 71 hospital referral regions (HRR). The total RPs decreased from 14,801 to 14,420 during the study period. Thirty six (51%) HRRs had at least 1 hospital with a surgical robot by 2005; 67 (12%) hospitals acquired at least 1 surgical robot. Adjusted, clustered generalized estimating equations analysis demonstrated that HRRs with greater numbers ofhospitals acquiring robots had higher increases in RPs than HRRsacquiring none (mean changes in RPs for HRRs with 9, 4, 3, 2, 1, and 0 are 414.9, 189.6, 106.6, 14.7, -11.3, and -41.2; P<0.0001). Hospitals acquiring surgical robots increased RPs by amean of 29.1 per year, while those without robots experienced a mean change of -4.8, P<0.0001.
CONCLUSIONS: Surgical robot acquisition is associated with increased numbers of RPs at the regional and hospital levels. Policy makers must recognize the intimate association between technology diffusion and procedure utilization when approving costly new medical devices with unproven benefit.
Note. In a news release, the lead author said:
"The use of the surgical robot to treat prostate cancer is an instructive example of an expensive medical technology becoming rapidly adopted without clear proof of its benefit," said Danil V. Makarov, MD, MHS, assistant professor, Department of Urology at NYU Langone Medical Center and assistant professor of Health Policy at NYU Wagner School of Public Health. "Policymakers must carefully consider what the added-value is of costly new medical devices, because, once approved, they will most certainly be used."
"Patients should be aware that if they seek care at a hospital with a new piece of surgical technology, they may be more likely to have surgery and should inquire about its risks as well as its benefits," said Dr. Makarov. "Hospitals administrators should also consider that new technology may increase surgical volume, but this increase may not be sufficient to compensate for its cost."