599 - Assessing the Use of Robotic Surgical Technology in Pediatric Surgery: A National Analysis
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 599 Publication Number: 599.32
Harold J. Leraas, Duke University Department of Surgery, Durham, NC, United States; Julie Thamby, Duke University School of Medicine, Durham, NC, United States; Catherine Beckhorn, Duke University School of Medicine, Durham, NC, United States; Claire Washabaugh, Duke University School of Medicine, Durham, NC, United States; Carrie Colleen. Moore, Texas Children's Hospital, Houston, TX, United States; Diego Schaps, Duke University School of Medicine, Durham, NC, United States; Sabino Zani, Duke University School of Medicine, Durham, NC, United States; Katharine L. Jackson, Duke University School of Medicine, Raleigh, NC, United States; Elisabeth T. Tracy, Duke Children's Hospital and Health Center, Chapel Hill, NC, United States
Medical Student Duke University School of Medicine Durham, North Carolina, United States
Background: Robotic surgery is becoming widely adopted in surgical practice from routine to complex procedures, particularly in adult patient populations. However, pediatric surgery is seen as lagging behind other surgical disciplines in the use of a robotic approach, yet there is a lack of literature quantifying the use of robotic surgery in children. Objective: We sought to assess the current use of robotic surgical technology in children. Design/Methods: We reviewed the Kids’ Inpatient Database (KID) from 2019 for patients under the age of 18 with procedural codes indicating the use of robot-assisted surgery. We conducted a cross-sectional analysis to describe the current use of robotic technology in pediatric surgical practice in the United States and to highlight the breadth of operations performed, regional variations in practice, and patient demographics. Results: We identified a total of 1228 children who underwent abdominal robot-assisted surgical intervention. Median age was 11 years (IQR 4-17 years). Patient demographics demonstrated that 59.15% of patients identified as White, 21.50% as Hispanic, and 9.84% as Black. Private insurance was held by 52.85% of patients, while 41.68% had Medicaid, and 1.47% were self-pay. Procedures were recorded at 635 unique hospitals. Regional examination demonstrated that 37.05% of cases occurred in the Southern US, followed by 23.05% in the West, 20.60% in the Midwest, and 19.30% in the Northeast. Urban teaching hospitals most commonly employed robotic surgical technology in children (96.17% of cases). In reviewing the breadth of operations performed using robotic technology, we identified 401 unique procedural codes. The five most common primary procedures performed in children were: 1. Repair of Kidney or Renal Pelvis (N=308), 2. Nephrectomy (N=90), 3. Repair of Ureter (N=80), 4. Cholecystectomy (N=73), and 5. Sleeve Gastrectomy (N=39).
Conclusion(s): The robotic approach is being utilized primarily in school-age children and adolescents, with few infants or young children. The most common procedures were urologic procedures and nephrectomies, followed by pediatric general surgery procedures. Notably, the largest proportion of children receiving robot-assisted surgery were white and treated in urban teaching hospitals, which suggests future research directions in reducing these racial and geographic health disparities. As this technology continues to integrate with pediatric surgical practice, care should be taken to ensure the adequate training of faculty, patient safety, cost-effective clinical outcomes, and more equitable access to this technology.
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