Tuesday, July 29, 2014

Debunking the debunking

I really don't want to write more about surgical robots, but you folks out there keep sending good material.  Here's an article by a surgeon on ThirdAge.com "debunking the myths about robotic surgery."

Let's look some assertions:

The robotics technology is expensive and the whole surgical team has to be trained, which can add to the cost. But there’s also a tremendous savings compared with traditional surgery because the patient is out of the hospital more quickly and there are fewer complications.

Many times, the robotics-assisted procedures can be done much more quickly, so there’s less risk simply because the duration of the procedure is shorter. You also have the smaller incisions, and less bleeding, factors that reduce the risks.

This kind of fast and loose talk is a discredit to the profession. I wish there were an agreement that we would rely solely on sound research studies instead of this anecdotal tripe.

Will you be in Panama City in August?

This is a must-see exhibit by the Smithsonian Tropical Research Institute.  A good chance to meet Matt Larsen, STRI’s new director, too.

Keeping up with the Joneses

Just by casual observation, I have asserted that a hospital was more likely to acquire a surgical robot if a nearby competitor hospital had already done so.  But this was an untested conclusion, based on viewing websites and highway signs, particularly from community hospitals, like above.  So I was intrigued to see this great article by Huilin Li (Department of Population Health, New York University) and others in Healthcare.  From the abstract:


The surgical robot has been widely adopted in the United States in spite of its high cost and controversy surrounding its benefit. Some have suggested that a “medical arms race” influences technology adoption. We wanted to determine whether a hospital would acquire a surgical robot if its nearest neighboring hospital already owned one.


We identified 554 hospitals performing radical prostatectomy from the Healthcare Cost and Utilization Project Statewide Inpatient Databases for seven states. We used publicly available data from the website of the surgical robot's sole manufacturer (Intuitive Surgical, Sunnyvale, CA) combined with data collected from the hospitals to ascertain the timing of robot acquisition during year 2001 to 2008. One hundred thirty four hospitals (24%) had acquired a surgical robot by the end of 2008. We geocoded the address of each hospital and determined a hospital's likelihood to acquire a surgical robot based on whether its nearest neighbor owned a surgical robot. We developed a Markov chain method to model the acquisition process spatially and temporally and quantified the “neighborhood effect” on the acquisition of the surgical robot while adjusting simultaneously for known confounders.


After adjusting for hospital teaching status, surgical volume, urban status and number of hospital beds, the Markov chain analysis demonstrated that a hospital whose nearest neighbor had acquired a surgical robot had a higher likelihood itself acquiring a surgical robot (OR=1.71, 95% CI: 1.07–2.72, p=0.02).


There is a significant spatial and temporal association for hospitals acquiring surgical robots during the study period. Hospitals were more likely to acquire a surgical robot during the robot's early adoption phase if their nearest neighbor had already done so.