Trends in Robot-Assisted Procedures for General Surgery in the Veterans Health Administration

Michael A Mederos; R Lorie Jacob; Rachel Ward; Rivfka Shenoy; Melinda M Gibbons; Mark D Girgis; Devan Kansagara; Denise Hynes; Paul G Shekelle; Karli Kondo

doi:10.1016/j.jss.2022.06.055

Trends in Robot-Assisted Procedures for General Surgery in the Veterans Health Administration

J Surg Res. 2022 Nov:279:788-795. doi: 10.1016/j.jss.2022.06.055. Epub 2022 Aug 12.

Authors

Affiliations

¹ Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Veterans' Health Administration, Greater Los Angeles Health Care System, Los Angeles, California. Electronic address: [email protected].
² Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.
³ Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon.
⁴ Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Veterans' Health Administration, Greater Los Angeles Health Care System, Los Angeles, California.
⁵ Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon; Department of Medical Informatics & Epidemiology, Oregon Health and Science University, Portland, Oregon.
⁶ Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; College of Public Health and Human Services, Oregon State University, Corvallis, Oregon.
⁷ Evidence Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, California.
⁸ Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, Portland, Oregon; Research Integrity Office, Oregon Health and Science University, Portland, Oregon; Department of Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia.

PMID: 35970011
DOI: 10.1016/j.jss.2022.06.055

Abstract

Introduction: Implementation of robot-assisted procedures is growing. Utilization within the country's largest healthcare network, the Veterans Health Administration, is unclear.

Methods: A retrospective cohort study using data from the Department of Veterans Affairs Corporate Data Warehouse from January 2015 through December 2019. Trends in robot utilization for cholecystectomy, ventral hernia repair, and inguinal hernia repair were characterized nationally and regionally by Veterans Integrated Services Network. Patients, who underwent laparoscopic repairs for these procedures and open hernia repairs, were included to determine proportion performed robotically.

Results: We identified 119,191 patients, of which 5689 (4.77%) received a robotic operation. The proportion of operations performed robotically increased from 1.49% to 10.55% (7.08-fold change; slope, 2.14% per year; 95% confidence interval [0.79%, 3.49%]). Ventral hernia repair had the largest growth in robotic procedures (1.51% to 13.94%; 9.23-fold change; slope, 2.86% per year; 95% confidence interval [1.04%, 4.68%]). Regions with the largest increase in robotic utilization were primarily along the Northeast, Midwest, and West Coast.

Conclusions: Robot utilization in general surgery is increasing at different rates across the United States in the Veterans Health Administration. Future studies should investigate the regional disparities and drivers of this approach.

Keywords: Robotic surgery; Utilization; Veterans.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Hernia, Inguinal* / surgery
Hernia, Ventral* / surgery
Herniorrhaphy / methods
Humans
Laparoscopy* / methods
Retrospective Studies
Robotic Surgical Procedures* / methods
Robotics*
United States
Veterans Health

Grants and funding

IK6 HX003395/HX/HSRD VA/United States