Trends in the adoption of robotic technology for radical cystectomy: A population-based analysis.

Abstract

311 Background: The adoption of the da Vinci Surgical System (Intuitive Surgical, Inc.) for robotic surgery requires a substantial financial investment by hospitals, acquisition of new surgical skills by surgeons, and demand from patients. Although the benefits of this technology have been previously described, the prevalence and adoption rate for robotics in the management of bladder cancer is not currently known. We performed a population-based analysis to determine how the introduction of robotic technology has altered the surgical management of bladder cancer. Methods: We analyzed patient-level data from the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the United States. We captured all patients who underwent a radical cystectomy with a diagnosis of bladder cancer between January 1, 2003, and December 31, 2010, based on codes from the International Classification of Disease, 9th edition. Radical cystectomies utilizing the da Vinci Surgical System were identified by a detailed review of the hospital charge data. Results: There was an increase in an overall adoption of robotic radical cystectomy from <2% in 2003 to 23% in 2010. Since 2005, teaching hospitals had a relative increased utilization of robotic radical cystectomy by approximately 40% each year compared to non-teaching hospitals. Hospitals in the West had the highest odds (odds ratio [OR] 3.1, p<0.001 [vs Midwest]) of utilizing robotic surgery for radical cystectomy while larger hospitals (>200 beds) were more likely to adopt robotic technology for radical cystectomy (OR 1.78, p<0.0001). Conclusions: There has been a relatively rapid adoption of the da Vinci Surgical System in the performance of radical cystectomy. This increased utilization is potentially secondary to the acquisition of robotic surgical skills and familiarity with transperitoneal pelvic anatomy following the widespread use of robotic technology for radical prostatectomy during the same time period.