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The introduction of robotic assisted surgery improved rates of minimally invasive surgery across different ages, among men and women, and types of insurance.

Data indicates that minimally invasive surgery (MIS) has improved patient outcomes across a range of different surgical procedures. MIS has traditionally been performed via laparoscopic devices, which has limitations. Robotic-assisted surgery (RAS) can address some of the barriers associated with laparoscopy.

For a study published in the Annals of Surgery Open, researchers conducted a retrospective cohort study assessing whether the introduction of RAS has increased MIS for common general surgery procedures and whether this increase was seen across different patient populations.

Brian Mitzman, MD, MSCI, and colleagues used data from an all-payer discharge database of US hospitals. Hospitals that performed cholecystectomy, inguinal hernia repair, ventral hernia repair, and colorectal resection from 2016 to 2022 were included. The primary analysis evaluated MIS rates, defined as the rate of common general surgeries that were MIS (laparoscopic or RAS) in a hospital. The secondary analysis examined MIS rates for common general surgeries across different individual characteristics.

Of the 408 hospitals included in the study, 38% began using RAS for general surgery procedures from 2017 to 2021. Most of them introduced RAS in larger hospitals, teaching hospitals, and urban areas. They also had higher rates of colorectal resection and lower rates of inguinal hernia than hospitals that did not introduce RAS.

RAS Improves MIS Rates for Multiple Patient Populations

Among hospitals that did not introduce RAS for common general surgeries, the rate of MIS increased slightly, from 56.1% to 57.0%. In hospitals that introduced RAS for these procedures, the researchers found a significantly higher increase in MIS rate from 60.5% to 65.8%. The relative MIS rate for hospitals that introduced RAS versus hospitals that did not went from 1.08 (95% CI, 1.02-1.14; P<0.01) before the index date to 1.15 (95% CI, 1.09-1.22; P<0.01) after the index date, indicating a larger increase in MIS rates among hospitals introducing RAS.

MIS rates increased significantly in hospitals with RAS across patient age, sex, ethnicity, race, and payer demographics. This was observed among:

• Patients aged 35 years and older (relative risk [RR], 1.08 (95% CI, 1.03-1.12)
  • Men (RR, 1.14; 95% CI, 1.10-1.19) and women (RR, 1.04; 95% CI, 1.02-1.06)
  • Hispanic (RR, 1.11; 95% CI, 1.03-1.19) and White patients (RR, 1.09; 95% CI, 1.06-1.12)
  • Patients with commercial insurance (RR, 1.08; 95% CI, 1.05-1.12) or Medicare coverage (RR, 1.13; 95% CI, 1.08-1.18)

“In our study, we demonstrated that hospitals introducing RAS were associated with an increase in overall rates of MIS for common general surgery operations compared with hospitals that did not introduce RAS,” Dr. Mitzman and colleagues wrote. “In addition, hospitals introducing RAS saw increases in MIS rates across patient age, sex, ethnicity, race, and payor, demonstrating that the introduction of RAS increases access to MIS for many different patient populations.”