Wednesday, March 20, 2013

Robot Rebuked

Once again, a paper has come out evaluating the efficacy and cost effectiveness of daVinci Robotic surgery.  From Diseases of the Colon & Rectum comes a retrospective review assessing elective robotic vs laparoscopic colectomy from 2008-2009 (over 12,000 procedures):
Patients undergoing robotic and laparoscopic procedures experienced similar rates of intraoperative (3.0% vs 3.3%; adjusted OR = 0.88 (0.35–2.22)) and postoperative (21.7% vs 21.6%; adjusted OR = 0.84 (0.54–1.30)) complications, as well as risk-adjusted average lengths of stay (5.4 vs 5.5 days, p = 0.66). However, robotic-assisted colectomy resulted in significantly higher costs of care ($19,231 vs $15,807, p < 0.001). Although the overall postoperative morbidity rate was similar between groups, the individual complications experienced by each group were different.

This comes on the heels of a study in the gynecology literature that demonstrated similar conclusions.  It is becoming increasingly clear that robotic surgery, as presently constituted,  is starting to define itself out of mainstream surgery (although certainly it will continue to play a niche role for certain procedures like prostate surgery, bariatrics, and low rectal resections).  The data simply doesn't support the PR blitzkrieg that has overtaken hospital systems throughout the country and the rush to buy million dollar robots and implement them for every conceivable procedure.  The results are incontrovertible.  For most surgical procedures the robot adds significant cost burden without providing any meaningful improvement in outcomes, morbidity, or patient satisfaction. 

In this era where exploding health care costs remains one of our nation's primary long term challenges, I find it hard to believe that the robotic surgery can be justified to the extent that the good people at daVinci would have us believe.  Unless.... we implement a single payer health care system and grant it the power to unilaterally negotiate reasonable reimbursement rates with market oriented ventures like Intuitive Surgical....

No comments: