Hospital learning curves for robot-assisted surgeries: a population-based analysis

• Published in: Surgical endoscopy Vol. 38; no. 3; pp. 1367 - 1378
• Main Authors: Walker, Richard J. B., Stukel, Thérèse A., de Mestral, Charles, Nathens, Avery, Breau, Rodney H., Hanna, Waël C., Hopkins, Laura, Schlachta, Christopher M., Jackson, Timothy D., Shayegan, Bobby, Pautler, Stephen E., Karanicolas, Paul J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Cancer; Codes; Cohort analysis; Cohort Studies; Endoscopy; Epidemiology; Female; Gastroenterology; Gynecology; Health care policy; Health sciences; Hepatology; Hospitals; Humans; Hysterectomy; Laparoscopy; Learning Curve; Learning curves; Length of stay; Male; Medicine; Medicine & Public Health; Oncology; Ontario; Patients; Personal health; Population; Proctology; Prostatectomy - adverse effects; Robotic surgery; Robotic Surgical Procedures - methods; Surgeons; Surgery; Thoracic surgery; Treatment Outcome; Urology; Ontario; Operative time; Learning curve; Robotic surgical procedures; Postoperative complications; Length of stay
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-023-10625-6

Background Robot-assisted surgery has been rapidly adopted. It is important to define the learning curve to inform credentialling requirements, training programs, identify fast and slow learners, and protect patients. This study aimed to characterize the hospital learning curve for common robot-assisted procedures. Study design This cohort study, using administrative health data for Ontario, Canada, included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using four arms (RPL-4) between 2010 and 2021. The association between cumulative hospital volume of a robot-assisted procedure and major complications was evaluated using multivariable logistic models adjusted for patient characteristics and clustering at the hospital level. Results A total of 6814 patients were included, with 5230, 543, 465, and 576 patients in the RARP, TRH, RAPN, and RPL-4 cohorts, respectively. There was no association between cumulative hospital volume and major complications. Visual inspection of learning curves demonstrated a transient worsening of outcomes followed by subsequent improvements with experience. Operative time decreased for all procedures with increasing volume and reached plateaus after approximately 300 RARPs, 75 TRHs, and 150 RPL-4s. The odds of a prolonged length of stay decreased with increasing volume for patients undergoing a RARP (OR 0.87; 95% CI 0.82–0.92) or RPL-4 (OR 0.77; 95% CI 0.68–0.87). Conclusion Hospitals may adopt robot-assisted surgery without significantly increasing the risk of major complications for patients early in the learning curve and with an expectation of increasing efficiency. Graphical abstract