Wednesday, May 5, 2010

Robots & Quality Health Care

In yesterday's Wall Street Journal, John Carreyou talks about da Vinci (the robot, not the artist).  The da Vinci is a robot used to perform minimally invasive surgeries.  The machine costs between $1.4 million and $2.2 million and is manufactured by Intuitive Surgical.  It's operated by surgeons with joystick controls with the purpose of providing better visibility and greater flexibility and ease in surgeries.  

Tha da Vinci then is argued to be good for patients because leads to: less blood loss, smaller scars, and less infection.  Additionally, one study found da Vinci surgeries to cut hospital stays, thus reducing hospital costs by a third.  Sounds great, but what are the potential problems?

For one, if unexperienced doctors are performing these procedures, there could be harmful outcomes for patients.     

The da Vinci has been marketed as a technological advantage for small hospitals to be competitive with other hospitals.  One such hospital, Wentworth-Douglas Hospital, in Dover, New Hampshire, has been using the da Vinci for years.   The hospital has performed about 300 surgeries in 4 years.  As a comparison, individual robotic surgery experts, like Dr. David Samadi at Mt. Sinai, average 400-600 per year.  Now, Wentworth-Douglas hospital is under investigation for quality concerns with the robotic surgeries.  There have been some complications in surgeries, but the hospital also notes their da Vinci complication rates are below some recently published rates.

There isn't current data to compare the rates of complications across hospitals, comparing high-volume (high number of procedures in a year) to low-volume.  However, there is data on number of procedures and offsetting cots.  One recent study in the Journal of Urology said that doctors need to perform over 500 per year to offset costs of traditional surgery.

So how can we ensure that we can allow for technological innovation while ensuring consistently high quality medical care delivered to patients and keeping costs down?  If it takes continuous experience (i.e. high volume hospitals, specifically the physicians in the hospitals, performing the procedures frequently) to ensure top-notch quality, how do we ensure access to top quality to less-resourced areas?  Can we ensure equality in quality geographically?

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