Surgical Robots Linked to Increased Rates of Partial Nephrectomy

Hospitals acquiring surgical robots are more likely to perform guideline-recommended partial nephrectomy in patients with renal cancer, reports a study in Medical Care.

The researchers used payer data from seven states to identify nearly 21,600 nephrectomies performed in 2001, 2005, and 2008. Hospital-level rates of partial nephrectomy were analyzed in relation to the hospitals’ acquisition of a surgical robotic system. The association was adjusted for nephrectomy volume, year of surgery, and other hospital factors.

Hospitals performed more partial nephrectomies after acquiring surgical robots. For hospitals acquiring robots between 2001 and 2004, the proportion of partial nephrectomies increased by about 30 percent in 2005 and 35 percent in 2008. A smaller increase of 15.5 percent was noted for hospitals acquiring a surgical robot between 2005 and 2008.

Hospitals with a higher nephrectomy volume and those in urban locations had higher rates of partial nephrectomy. At hospitals that had not acquired a robotic system by 2008, partial nephrectomy was performed in just 20 percent of cases.

Nephron-sparing surgery is a guideline-supported but underused alternative to radical nephrectomy for patients with renal cancer. The new analysis suggests that surgical robots—a costly and controversial use of technology—facilitate the performance of partial nephrectomy in this group of patients.

“This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care,” the researchers write. They discuss the implications for adoption of new technologies, noting that the “earliest adopters” of surgical robots had the greatest increases in partial nephrectomy [Sivarajan G, et al. The effect of the diffusion of the surgical robot on the hospital-level utilization of partial nephrectomy. Med Care 2015; 53:71–78].