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Rapid Adoption of Robotic Surgery: Risks, Benefits, and Unintended Consequences

机器人手术的快速采用：风险、益处和意外后果

基本信息

批准号：
10338410
负责人：
Justin Brigham Dimick
金额：
$ 53.63万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-21 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10338410
关键词：
Adoption Anatomy Cholecystectomy Clinical Clinical Data Colon Carcinoma Complication Country Data Decision Making Diffuse Diffusion Effectiveness Ensure Expenditure Goals Growth Health Expenditures Hernia Heterogeneity Hospitals Incidence Inguinal Hernia Laparoscopic Surgical Procedures Learning Medical Medicare Observational Study Operative Surgical Procedures Outcome Patients Perioperative Postoperative Complications Privatization Procedures Professional Organizations Provider Records Rectal Cancer Recurrence Reporting Risk Robotics Safety Selection Bias Surgeon System Technology Time trend United States Variant Ventral Hernia Work base cancer surgery care episode clinical practice colon surgery comparative comparative safety cost design evidence base experience improved interest new technology operation population based randomized trial repaired robotic system skills standard of care surgical risk treatment effect trend

项目摘要

PROJECT SUMMARY The United States now performs more robotic surgery than all other countries combined. While the overall volume of robotic surgery has tripled in the past decade, its use for the most common general surgery operations (e.g. inguinal hernia repair or gallbladder removal) has increased more than 24- fold over this same period. Despite this, evidence regarding the use and clinical outcomes of robotic surgery for these operations is limited – putting patients at risk between enthusiasm for a new surgical technology and insufficient evidence to justify large changes in clinical practice. Existing observational studies lack appropriate controls and the small number of randomized trials focus on narrow clinical domains (e.g. surgery for rectal cancer) with carefully selected patients and the most experienced surgeons. This proposal uses a combination of Medicare and private payer claims data to characterize the real-world adoption, outcomes, and health care expenditures of robotic surgery for common general surgical operations. We focus on inguinal/ventral hernia repair, cholecystectomy, and surgery for colon and rectal cancer – the clinical domains experiencing the largest growth in robotic surgery. We leverage natural variation in the regional adoption of robotic surgery as an instrumental variable to mitigate issues of selection bias that limit prior observational studies estimating the outcomes of robotic surgery. We use this approach to explore the short-term comparative safety (e.g. incidence of postoperative complications), spending for the surgical episode of care, and long-term effectiveness (e.g. hernia recurrence) of robotic surgery relative to the more established laparoscopic and open approaches for each operation. We assess for heterogeneity in outcomes across surgeons with varying degrees of experience performing robotic surgeries. The results from this study will have immediate relevance to patients and providers making treatment decisions around the safest and most effective approach for surgery. It will also inform the work of policymakers and professional societies who share a common interest in ensuring the safe diffusion of new surgical technologies. Finally, these data will provide public and private payers – who are jointly moving towards greater use of evidence-based coverage design – with data to improve the value of expensive surgical interventions in the United States.

项目总结