Abstract: PD09-12
Sources of Funding: None.

Introduction

Robot use for assistance with partial nephrectomies (PN) has increased drastically over the past decade with adoption rates by robot-naive surgeons continuing to rise steadily. Despite this, little is known about the impact of surgeon experience and hospital volume on peri-operative outcomes and the cost of management for patients undergoing robotic PN. Thus, we sought to compare peri-operative success and in-hospital cost between surgeons and hospitals with low, medium and high robotic PN volumes.

Methods

Utilizing an all-payer hospital clinical and economic database, we identified a nationally representative sample of 50,282 patients undergoing robotic PN within the United States between 2003 and 2015 after survey weighting. Annual surgeon and hospital robotic PN volumes were calculated and surgeons and hospitals were subsequently divided into tertiles corresponding to low, medium and high volumes.

Results

High volume surgeons and hospitals had a significantly higher rate of older patients compared to their peers and were more likely to practice at a hospital that was academic, larger than 500 beds and in an urban setting (all p<0.001). Patients treated by high volume surgeons also had fewer overall complications compared to low volume surgeons (24.4% vs. 31.3%, p =0.002) as well as a 35% lower odds of having a major complication after adjusting for relevant patient and hospital characteristics (OR: .65, 95% CI: 0.47 to 0.90, p = 0.009). Hospitals performing a high volume of robotic PN also had fewer overall complications compared to low volume hospitals (24% vs. 27%, p=0.01) and 43% lower multivariate odds of having a major complication (OR: .57, 95% CI: 0.41 to 0.79, p=0.001). The patient's length of stay was significantly shorter for both high volume surgeons and hospitals, respectively, compared to low and medium volume surgeons (p<0.001). Total cost of stay after adjusting for inflation was not significantly different regardless of surgeon and hospital experience in robotic PN surgery. The mean decrease in cost for high volume surgeons and hospitals compared to their low volume peers was $28.6 (p=0.933) and $186.5 (p=0.56), respectively.

Conclusions

Increased experience in robotic PN by both surgeons and hospitals is associated with lower complication rates and shorter length of stays, but in-hospital cost is not significantly affected by provider experience.

Funding

None.