(152) Determinants of Use of Minimally Invasive Robot-Assisted Surgery: a Cohort Study from the French Nationwide Claims Database

Background
The use of robotic assistance (RA) in surgery has been booming internationally for several decades. In France, the tracking of RA procedures in claims databases have only been required since March 2020, and few studies have assessed the determinants associated with its use.
Objectives
To assess the determinants of the use of RA in surgery in France.
Methods
A cohort study was conducted between March 1, 2020 and June 30, 2023 from the National Health Data System (SNDS) among adults who underwent a first urological, gynecological, digestive, thoracic or ear, nose and throat (ENT) surgery in health facilities with a surgical robot. Determinants studied were temporal factors (seasons, COVID-19 lockdowns), patient characteristics (age, sex, deprivation of the residence area, Charlson Comorbidity Index (CCI)), and facilities type and surgical volume. For each surgical specialty, multivariate logistic regression models were used. Results were expressed in adjusted Odds Ratio (OR) and 95% confidence intervals (95% CI).
Results
Proportion of RA surgeries was 6.5% (N= 13,950/215,448) in digestive surgery, 9.5% (N= 11,499/120,748) in gynecology, 16.1% (N=572/3,548) in ENT surgery, 17.9% (N= 5,939/33,186) in thoracic surgery and 62.9% (N= 56,766/ 90,184) in urology. The use of RA increased i) during spring for urology and digestive surgery (1.10, 1.04-1.15; 1.06, 1.00-1.12), ii) with age for all specialties (p≤0.001) except for ENT surgery, iii) with CCI for digestive surgery and gynecology (1.02, 1.00-1.04; 1.13, 1.10-1.16), iv) in patients living in the lower area-level deprivation for digestive surgery (1.08, 1.04-1.12) and v) if thoracic surgeries were performed in general hospital compared to university hospital (1.17, 1.09-1.26). Conversely, the use of RA decreased i) in summer time for thoracic surgery (0.91, 0.82-0.99) compared to fall, ii) during lockdown periods compared with non-lockdown periods for all specialties (p≤0.001), except for ENT surgery, iii) among patients aged 50-60 years compared patients aged <50 years for ENT surgery, iv) in women compared to men for thoracic surgery (0.90, 0.84-0.97), v) in patients living in the lower area-level deprivation for urology, gynecology and ENT surgery (0.83, 0.80-0.86; 0.88, 0.84-0.92; 0.62, 0.49-0.78), vi) if urological, digestive, gynecological, thoracic and ENT surgeries were performed in private hospital compared to university hospital (0.79, 0.75-0.82; 0.28, 0.27-0.30; 0.20, 0.18-0.21; 0.49, 0.46-0.53; 0.05, 0.03-0.08), and vii) if urological, digestive, gynecological and ENT surgeries were performed in general hospital compared to university hospital (0.82, 0.78-0.86; 0.39, 0.37-0.41; 0,57, 0.54-0.60; 0,63, 0,49-0.80).
Conclusions
This large cohort showed that, among health facilities, temporal and socio-economic determinants, age, comorbidities and type of facility were associated with the use of RA in surgery, and that their effects varied according to the surgical specialty.