Project 467154

Robotic surgery expands the limits of what surgeons can achieve using a minimally invasive approach and is being rapidly adopted in Canada. However, the cost and longer operating times confer significant limitations. Policy makers and hospital administrators must therefore ensure the technology is applied in environments where patients are most likely to benefit. My research will determine the relationship between provider experience and outcomes to inform minimum volume and training standards that will protect patients. In a cohort of adult patients undergoing commonly performed robotic procedures, I will characterize (1) the learning curve, defined as the relationship between cumulative surgeon robotic case volume and postoperative complications, and (2) the volume-outcome relationship, defined as the association between annual hospital and surgeon robotic cases and complications.The study population will include all adult patients who underwent an elective robot-assisted radical prostatectomy, nephrectomy, hysterectomy, or lung lobectomy between 2009 and 2020 in Ontario. The primary outcome will be complications within 30-days of surgery. Secondary outcomes will include 30-day mortality, 30-day readmission, unplanned intensive care unit admission, and cancer recurrence, where applicable.The available literature is ill-suited to answer these questions. This will be the largest study to report the learning curves and volume-outcome relationships for robotic surgeries. The results will inform policy makers, hospital administrators, and certification guidelines in Canada and worldwide.