The debate continues with regard to the effectiveness of robotic surgery for certain indications. We’ve blogged about robotic surgery before when we reviewed an article published in the Journal for Healthcare Quality (Jin LX et al. Robotic surgery claims on United States hospital websites) that examined the prevalence, prominence, and type of robotic surgery content that appeared on the websites of 400 randomly selected hospitals in the United States. That analysis found that a majority of hospitals that discussed robotic surgery on their websites made unsupported claims about the clinical superiority of robotic surgery. Recent comparative effectiveness research published in the Journal of Clinical Oncology shows that the science still doesn’t back healthcare claims about robotic surgery.
A team from the Columbia University College of Physicians and Surgeons performed the retrospective analysis of 2464 women who underwent laparoscopic or robotic hysterectomy for endometrial cancer from 2008 to 2010. Among these, 41% underwent laparoscopic hysterectomy and 58.3% underwent robotic hysterectomy. Using statistical models, the researchers compared morbidity, mortality, and the cost of each procedure. Despite healthcare claims of decreased complications using robotic surgery, the research team found no significant differences in patient outcomes, rates of overall complications, or prolonged hospitalization between the procedures. There was, however, a significant cost increase attributed to the robotic hysterectomy. After adjusting for patient characteristics, surgeon factors, and hospital characteristics, the direct hospital costs for robotic surgery were $1291 higher than laparoscopic hysterectomy.
Robotic surgery is just one example of a new technology that was embraced and disseminated before appropriate efficacy and safety data were available. And, at a cost of anywhere from a million to 2.5 million dollars, it represents a huge expenditure for hospitals.
The question is, is it worth it? As these data in women with endometrial cancer show, there is virtually no difference in patient outcomes between the robotic procedure and laparoscopic surgery. Although both procedures are well tolerated, robotic surgery is significantly more expensive, so what’s the benefit?