%0 Journal Article
%T Hospital volume-outcome relationships for robot-assisted surgeries: a population-based analysis.
%A Walker RJB
%A Stukel TA
%A de Mestral C
%A Nathens A
%A Breau RH
%A Hanna WC
%A Hopkins L
%A Schlachta CM
%A Jackson TD
%A Shayegan B
%A Pautler SE
%A Karanicolas PJ
%J Surg Endosc
%V 38
%N 8
%D 2024 Aug 27
%M 38937312
%F 3.453
%R 10.1007/s00464-024-10998-2
%X <B>BACKGROUND: </B>Associations between procedure volumes and outcomes can inform minimum volume standards and the regionalization of health services. Robot-assisted surgery continues to expand globally; however, data are limited regarding which hospitals should be using the technology.<BR><B>METHODS: </B>Using administrative health data for all residents of Ontario, Canada, this retrospective cohort study 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 4 arms (RPL-4) between January 2010 and September 2021. Associations between yearly hospital volumes and 90-day major complications were evaluated using multivariable logistic regression models adjusted for patient characteristics and clustering at the level of the hospital.<BR><B>RESULTS: </B>A total of 10,879 patients were included, with 7567, 1776, 724, and 812 undergoing a RARP, TRH, RAPN, and RPL-4, respectively. Yearly hospital volume was not associated with 90-day complications for any procedure. Doubling of yearly volume was associated with a 17-min decrease in operative time for RARP (95% confidence interval [CI] - 23 to - 10), 8-min decrease for RAPN (95% CI - 14 to - 2), 24-min decrease for RPL-4 (95% CI - 29 to - 19), and no significant change for TRH (- 7 min; 95% CI - 17 to 3).<BR><B>CONCLUSIONS: </B>The risk of 90-day major complications does not appear to be higher in low volume hospitals; however, they may not be as efficient with operating room utilization. Careful case selection may have contributed to the lack of an observed association between volumes and complications.