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Dock the Robot for the Injured Patient: Patterns and Trends of Robotic Surgery Use in Trauma Patients
Yasmin Arda1, Vahe S Panossian, Ikemsinachi C Nzenwa
1From the Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Background:
Robotic surgery (RobSurg) usage has increased in multiple surgical fields. We aimed to review recent trends in RobSurg use in trauma surgery and hypothesized that its use is increasing and varies across hospital types.
Study Design:
The 2017 to 2020 American College of Surgeons-TQIP database was used to identify all injured patients 18 years or older undergoing RobSurg, defined by robotic ICD-10 procedure codes. We examined the annual trends of RobSurg use. We then examined patient demographics, mechanisms of injury, time to surgery, procedures performed, hospital type, outcomes (eg mortality, postoperative complications), and conversion to open surgery.
Results:
Of 4,005,762 trauma patients, 1,391,350 (34.7%) underwent surgical procedures, of which 210 (15 of 100,000) were robotic. The use of RobSurg has increased from 7.5 per 100,000 procedures in 2017 to 25.5 per 100,000 in 2020 (p < 0.001). The median age was 55 years, 88.6% had a blunt mechanism of injury, 6.7% had gunshot wounds, and 4.8% had stab wounds. RobSurg most commonly involved the lung (17.1%), spine (13.8%), and diaphragm (4.3%). Only 3 patients (1.4%) underwent a nonspecific robotic peritoneal exploration for trauma. The median time to surgery was 76 hours (interquartile range 30 to 170.2), the rate of conversion to open was 28%, and mortality was 3.3%. Nonteaching hospitals performed RobSurg more frequently than teaching hospitals (19.2 per 100,000 procedures in nonteaching vs 10.5 per 100,000 in teaching hospitals, p < 0.001). RobSurg was also more frequent in lower-level trauma centers (12.2 per 100,000 in level I, 17.6 per 100,000 in level II, and 22.6 per 100,000 in level III trauma centers, p = 0.04).
Conclusions:
RobSurg use in the trauma setting remains limited but perhaps increasing, especially in nonteaching and level II or III trauma centers, with its use largely restricted to subacute interventions. Further studies are needed to examine the effectiveness of RobSurg compared with open or laparoscopic surgery in injured patients.
