Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-018-6554-9 Robotic surgery trends in general surgical oncology from the National Inpatient Sample Camille L. Stewart 1  · Philip H. G. Ituarte 1  · Kurt A. Melstrom 1  · Susanne G. Warner 1  · Laleh G. Melstrom 1  · Lily L. Lai 1  · Yuman Fong 1  · Yanghee Woo 1 Received: 21 August 2018 / Accepted: 17 October 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background Robotic surgery is ofered at most major medical institutions. The extent of its use within general surgical oncology, however, is poorly understood. We hypothesized that robotic surgery adoption in surgical oncology is increasing annually, that is occurring in all surgical sites, and all regions of the US. Study design We identifed patients with site-specifc malignancies treated with surgical resection from the National Inpatient Sample 2010–2014 databases. Operations were considered robotic if any ICD-9-CM robotic procedure code was used. Results We identifed 147,259 patients representing the following sites: esophageal (3%), stomach (5%), small bowel (5%), pancreas (7%), liver (5%), and colorectal (75%). Most operations were open (71%), followed by laparoscopic (26%), and robotic (3%). In 2010, only 1.1% of operations were robotic; over the 5-year study period, there was a 5.0-fold increase in robotic surgery, compared to 1.1-fold increase in laparoscopy and 1.2-fold decrease in open surgery (< 0.001). These trends were observed for all surgical sites and in all regions of the US, they were strongest for esophageal and colorectal operations, and in the Northeast. Adjusting for age and comorbidities, odds of having a robotic operation increased annually (5.6 times more likely by 2014), with similar length of stay (6.9 ± 6.5 vs 7.0 ± 6.5, p = 0.52) and rate of complications (OR 0.91, 95% CI 0.83–1.01, p = 0.08) compared to laparoscopy. Conclusions Robotic surgery as a platform for minimally invasive surgery is increasing over time for oncologic operations. The growing use of robotic surgery will afect surgical oncology practice in the future, warranting further study of its impact on cost, outcomes, and surgical training. Keywords Robotic surgery · Minimally invasive surgery · National Inpatient Sample In the year 2000, the frst robotic-assisted surgery platform was approved by the United States (US) Food and Drug Administration [1]. Since then, its role has continued to expand and robotic surgery is now ofered at most major medical institutions. While robotic surgery has become standard of care in surgical felds like urology, the fre- quency of robotic use within general surgical oncology is less consistent and is sparsely studied. The robotic platform ofers technologically sophisticated equipment to facilitate minimally invasive operations, but there are few conclusive clinical studies showing its superiority over traditional laparoscopy for surgical oncology operations [2]. Robotic surgery is also more expensive compared to traditional lapa- roscopy and open surgery. For these reasons, there is skepti- cism and controversy related to its use [3]. Understanding the level of use is important for directing future health care resources, and also guiding education and training in surgi- cal oncology procedures. The National Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality, is the largest all- payer inpatient care database in the US [4, 5]. It is a data- base of hospital inpatient discharges representing 97% of the US population [4, 5]. We sought to characterize the use of robotic surgery in general surgical oncology opera- tions, specifically its frequency of use overall, and trends and Other Interventional Techniques * Camille L. Stewart cstewart@coh.org 1 Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010-3000, USA