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Comment & Response |

Do Surgeons or Hospital Economics Ultimately Decide Operative Approach?

Richard S. Matulewicz, MD, MS1; Joshua J. Meeks, MD, PhD1
[+] Author Affiliations
1Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2016;151(9):883-884. doi:10.1001/jamasurg.2016.0830.
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To the Editor We commend Wright and colleagues1 on their assessment of several external, nonmedical factors associated with the use of robotic-assisted surgery (RAS). In their study,1 3 urologic procedures were included. They demonstrated that robotic-assisted laparoscopic prostatectomies were performed in a greater percentage of cases (67.6%) than robotic-assisted laparoscopic nephrectomies (6.8%) and robotic-assisted laparoscopic partial nephrectomies (34.2%). As hypothesized, after regression analysis, hospital competition and financial status were associated with use of RAS. However, among hospitals already owning a robot, this effect dissipated. Given these findings, we would like to offer 2 additional points of consideration relative to the study’s results: (1) the apparent differential adoption and diffusion of RAS among the 3 procedures and (2) the benefits of technology relative to the surgical learning curve.

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Correspondence

July 1, 2016
Jason D. Wright, MD; Ana I. Tergas, MD; June Y. Hou, MD; William M. Burke, MD; Ling Chen, MD, MPH; Jim C. Hu, MD, MPH; Alfred I. Neugut, MD, PhD; Cande V. Ananth, PhD, MPH; Dawn L. Hershman, MD
1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York3Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York3Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
2Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York5Department of Urology, Weill Cornell Medical College, New York, New York
2Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York3Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York6New York Presbyterian Hospital, New York
1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
JAMA Surg. 2016;151(7):612-620. doi:10.1001/jamasurg.2015.5508.
September 1, 2016
Jason D. Wright, MD; Dawn L. Hershman, MD
1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York3New York Presbyterian Hospital, New York
2Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York3New York Presbyterian Hospital, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York5Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
JAMA Surg. 2016;151(9):884. doi:10.1001/jamasurg.2016.0835.
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