Hospitals that purchase expensive, high-tech surgical robots perform more prostate surgeries, suggesting that availability of the technology could play a role in determining treatment decisions, according to a new study.
An analysis of hundreds of hospitals in seven states found that radical prostatectomies -- the surgical removal of the prostate -- to treat cancer was falling nationwide, from 14,801 in 2001 to 14,420 in 2005, according to data pulled from the Healthcare Cost and Utilization Project State Inpatient Databases. The slight dip could be caused by a switch to other treatments, such as radiation or hormone therapy, or a leveling off of cancer cases.
However, not all hospitals saw a downward trend. For hospitals that bought a surgical robot, the number of surgeries increased by on average 29 cases per year.
Hospitals that did not buy the robot had around 5 fewer surgeries each year.
"This may be the medical embodiment of the phrase, 'If you're a hammer, everything looks like a nail,'" lead author Dr. Danil V. Makarov, a urologist with at New York University's Langone Medical Center, told the New York Times.
The study, published in the journal Medical Care, looked at data from 554 community hospitals within 71 hospital referral regions in Arizona, Florida, Maryland, North Carolina, New York, New Jersey and Washington.
The retrospective analysis compared surgery rates in 2001, when the most popular and advanced surgical robot, Intuitive Surgical's da Vinci Surgical System, was approved by the U.S. Food and Drug Administration, with rates in 2005, after the robots had been more widely adopted.
By 2005, 67 hospitals, or 12 percent, had at least one robot, and half of referral regions had at least one hospital that owned a robot.
The researchers said the slight increase in surgeries with hospitals owning robots could be because they attract patients who are surgical candidates from other hospitals or because having a robot could influence the decision to go under the knife.
But pressure could also come from patients, who tend to favor using the most advanced technology available, according to some experts.
Speaking with DOTmed News reporter Olga Deshchenko last year, Dr. Eric Mayer, chief of minimally invasive urologic surgery at St. Luke's Hospital and Health Network, said
roughly 98 percent of prostate surgery patients at his hospital opted for robotic surgery.
Of the 70,000 or so prostatectomies performed in the United States in 2009, 70 to 80 percent were done with a robot,
according to Dr. Ash Tewari, professor of urology and outcomes at the Weill Cornell Medical Center and the director of the Lefrak Institute of Robotic Surgery at New York Presbyterian Hospital.
Even though the procedures are more popular, they're also more expensive -- about $2,000 costlier than traditional surgery, according to reports.
However, evidence for robotic surgeries having better outcomes is mixed. A study in the Journal of Urology last spring found "no significant difference between the open and robotic approaches with respect to urinary function, sexual function or bowel function," according to study co-author Dr. Michael Fabrizio, division chief of urology at the Sentara Medical Group in Virginia and an associate professor of urology at the Eastern Virginia Medical School.
