SAFETY AND FEASIBILITY OF ROBOTIC SURGERY IN A COUNTY HOSPITAL
Oscar A. Olavarria*, Karla Bernardi, Todd Wilson, Shinil Shah, Curtis J. Wray, Tien C. Ko, Lillian S. Kao, Mike K. Liang
General Surgery, McGovern Medical School at UTHealth, Houston, TX
Introduction:
Safety net hospitals, such as county hospitals, have been demonstrated to be outliers for surgical complications on multiple national databases. Reasons include low socioeconomic status patients with poorly controlled comorbid conditions, system based issues, and limited hospital resources. Adoption of complex technologies, such as robotic surgery, may not result in the same outcomes as those achieved in other facilities. The aim of this study was to determine the safety and feasibility of the adoption of robotic surgery in a county hospital.
Methods:
This was a review of the first 95 patients who underwent robotic assisted laparoscopic procedures at a single county hospital. Primary outcome was major complications defined as Clavien-Dindo class 3-5 complications within 30 days of surgery. Secondary outcomes included conversions from robotic to open procedures, blood transfusions, readmissions, reoperations, operative time, minor complications (Clavien-Dindo 1-2) including wound complications, and 30 day hospital length of stay. Multivariable linear regression was performed to identify variables associated with longer operative time.
Results:
A total of 95 patients underwent robotic assisted laparoscopic surgery between January-September 2018. Of these, 30 (31.6%) were overweight and 51 (53.7%) were obese, 19 (20%) had diabetes mellitus, 68 (71.5%) had a previous abdominal surgery and 14 (14.7%) had a previous ventral hernia repair (VHR). In our series: 69 (72.6%) patients had a VHR, 14 (14.7%) had an inguinal hernia repair of which 8 (8.4%) were bilateral, and 10 (10.5%) had foregut surgery (hiatal hernia repair, Heller myotomy or other gastroesophageal surgery). There was 1 major complication, a pulmonary embolism following a robotic hiatal hernia repair.
There were no conversions to open procedures, blood transfusions, procedure related readmissions or reoperations. The mean+/-SD operative time was 133+/-62 min. There were 3 surgical site occurrences (3 seromas) and no surgical site infections. The 30 day hospital length of stay, median (IQR), was 0 (0). On multivariable analysis, procedure type (ventral, unilateral-inguinal, bilateral-inguinal and foregut), previous abdominal surgery, and first fifty cases were independently associated with longer operative time.
Conclusion
Robotic assisted laparoscopic surgery is safe and feasible at a county hospital. Given the high risk patient population and high complication rate based upon national data, county hospitals may see substantial benefit by developing robotics programs. Further studies are needed to assess the effectiveness and value (outcomes/costs) of robotic platforms in general surgery and other specialties at safety net hospitals.
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