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EMBRACING FUTURE TECHNOLOGY: EVALUATING THE IMPACT OF ROBOTIC THORACIC SURGERY ON HOSPITAL SYSTEMS
MP Rogers, HM Janjua, E Eguia, L Lozonschi, EM Toloza, PC Kuo
University of South Florida

Background
Robotic-assisted surgery is an appealing and increasingly utilized option for surgical patients. We sought to evaluate the role of robotic-assisted lung surgery on hospital volume using Difference in Difference (DID). We propose hospital adoption of robotic thoracic technology increases total volume of specific procedures as compared to non-robotic hospitals.

Methods
The 2010-2015 Florida Agency for Health Care Administration Inpatient Data was queried for open, video-assisted thoracoscopic, and robotic-assisted lobectomy, segmentectomy, and wedge resection. Patient demographics were evaluated using chi square test, with p<0.05 considered significant. DID method was used to evaluate the impact of robotic thoracic technology to the selected surgical volume of robotic versus non-robotic hospitals. Incident Rate Ratios (IRR) from DID analysis determined the significance of robotic technology. For each technique within each procedure, length of stay (LOS) and elements of charges were compared for the raw and 1:1 propensity matched data to determine statistical significance.

Results
A total of 28,484 lung resection procedures were performed at 162 hospitals, 65 of which had robotic capabilities. Propensity-matched robotic-assisted lung resection procedures incurred significantly higher charges for medical/surgical supplies; however, mean LOS for robotic-assisted lung resection procedures was significantly shorter than that for propensity-matched video-assisted and open cases, leading to significantly decreased room and board charges. Robotic hospitals experienced an 85% increase in total lung surgical volume (IRR 1.85, p-value < 0.001). This increase in surgical volume was consistent for each type of lung resection procedure separately. IRR for lobectomy, segmentectomy, and wedge resection procedures were 1.67, 1.62, and 1.81, respectively (Table 1).

Conclusion
Hospital adoption of robotic technology significantly increases the overall lung surgical volume at the respective hospitals for select lung resection procedures. Hospitals should consider the benefits of introducing and adopting robotic technology, which leads to higher case volumes and decreased LOS, benefitting both hospital systems and patients.


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