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Hospital volume-outcome relationships for robot-assisted surgeries: a population-based analysis.

Richard J B Walker^1,2,3, Thérèse A Stukel^2,3, Charles de Mestral^2,3,4

¹Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.

Surgical Endoscopy

|June 27, 2024

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Summary

Robot-assisted surgery volumes did not correlate with 90-day major complications. Low-volume hospitals may be less efficient in operating room utilization, potentially due to careful case selection for complex procedures.

Area of Science:

Surgical Oncology
Urology
Gynecology
Thoracic Surgery

Background:

Robot-assisted surgery is expanding globally, but data on optimal hospital volumes for specific procedures are limited.
Understanding the relationship between procedure volume and patient outcomes is crucial for establishing minimum volume standards and guiding health service regionalization.

Purpose of the Study:

To investigate the association between yearly hospital volumes and 90-day major complications for four robot-assisted procedures.
To assess the impact of hospital volume on operative efficiency in robot-assisted surgery.

Main Methods:

Retrospective cohort study using administrative health data from Ontario, Canada (January 2010 - September 2021).
Included adult patients undergoing robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using 4 arms (RPL-4).

Keywords:

Length of stay Operative time Postoperative complications Robotic surgical procedures

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Multivariable logistic regression models adjusted for patient characteristics and hospital clustering were used to evaluate associations between yearly hospital volumes and 90-day major complications.

Main Results:

A total of 10,879 patients were analyzed across the four procedures.
Yearly hospital volume was not associated with increased 90-day major complications for any of the studied robot-assisted procedures.
Increased yearly volume was associated with decreased operative times for RARP, RAPN, and RPL-4, but not for TRH.

Conclusions:

The risk of 90-day major complications following these robot-assisted procedures does not appear to be higher in low-volume hospitals.
Low-volume hospitals may exhibit lower efficiency in operating room utilization.
Careful patient selection in lower-volume settings may contribute to the observed lack of association between volume and complications.