Research Brief: Increasing access to and affordability of robot-assisted surgeries
Advanced technology in the doctor’s office or in the surgical room can improve care for patients. However, the high costs associated with the purchase, training of physicians and upkeep of such advanced technology can limit access beyond the hospitals and patients who might have the means to afford it.
In a new study from the University of Minnesota Carlson School of Management, researchers looked at how hospital policies might impact the potential for broader access to technological advances that could contribute to high-quality, affordable healthcare.
The paper, published in The Journal of Operations Management, examined how to maximize the benefits of using the da Vinci surgical system in conducting robot-assisted hysterectomies while minimizing the cost of the surgery. Generally, when robots are introduced, surgical costs rise.
“Robots have a huge potential to disrupt the surgical supply chain in a good way,” said Kingshuk Sinha, professor and chair of the Department of Supply Chain and Operations, who co-authored the paper with Ujjal Mukherjee, a Ph.D. alum of the Carlson School and current faculty member at the University of Illinois at Urbana-Champaign. “On the demand side, patients want the best surgeons to provide their care. However, on the supply side, the pool of surgeons and opportunity to develop skills in the operating room — as, in this case, surgeons continue to learn and perfect their skills by conducting surgeries — can be limited.”
To better understand the relationship between surgeons, clinical outcomes and managing costs, researchers examined 200 hysterectomies at a hospital in the midwestern U.S. Fifty of the surgeries were conducted by manual laparoscopy, meaning the minimally invasive surgical procedure was done without the assistance of a robot, and 150 were robot-assisted.
Using that data, and through simulations, researchers examined these three hospital policies:
- The prioritization of patients for robot-assisted surgery based on how critical the patient was (i.e., the weight of the uterus, as the uterine weight is often a predictor of increased surgical duration, blood loss and length-of-stay at a hospital).
- The optimal size of the surgeon pool to allow for training on surgical robots: Researchers examined the number of surgeons available to ensure effective scheduling for training and surgical use of the robot(s), which — for hospitals that have them — are typically limited to one or two.
- The determination of the minimum experience level of a surgeon to be included in the surgical pool.
The study found:
- creating a threshold policy related to the criticality of the disease assists in improving clinical outcomes for the patients and keeps costs down;
- the learning curve for novice and expert surgeons is indistinguishable when it comes to their learning curve with a surgical robot, as the technology itself helps guide surgeons;
- models showed setting minimum experience levels for surgeries, ranging from conducting 25 to 50 surgeries, lowers the amount of blood lost, surgical time and cost;
- if all three policies surrounding robot-assisted surgeries are implemented, models show costs could be lower than manual laparoscopies and robot-assisted surgeries without the policies in place.
“Our research shows that if these technologies are deployed strategically, there are obvious surgical benefits and lower healthcare costs,” said Sinha, who has expertise in supply chain management in the healthcare and medical device sectors. “We hope that hospital systems can take this work and adapt it to meet the needs of their patients and surgeons.”