The Influence of Hospital Culture on the Successful Implementation of Robotic Cardiac Surgery
Robert S. Poston, Jr..
Northwest medical center, Tucson, AZ, USA.
OBJECTIVE: Robotic cardiac surgery adoption has been woefully inconsistent. Many teams have initiated robotic cardiac programs, but few have sustained its integration into routine practice. Surgeon skill plays a role in the high failure rate of this technically demanding procedure. Institutional factors that may influence the chances of success have never been systematically investigated or even seriously considered. We compared characteristics of institutions with active vs. failed robotic cardiac programs.
METHODS: Intuitive Surgical Corp has maintained a marketing database containing the location of all US institutions where robotic cardiac surgical cases have been performed. This database was queried for institutions that performed at least one major robotic cardiac procedure (CABG, valve repair) within the last 10 years. Institutions were defined as “active” (i.e. >50 robotic cases in the most recent year), “low volume” (between 1-49 cases in the last 2 years) and “failed” (no cases in the most recent 2 years). Using publically reported information, we compared institutional-level variables between active vs. failed programs: academic vs. private, hospital beds, cardiac surgical volume, public reporting of STS quality data (Y/N and composite quality score), and leapfrog safety score (range 2.0-3.2).
RESULTS: Within the last 10 years, 372 different institutions have attempted robotic cardiac surgery, distributed amongst robotic programs defined as active (n=24), low volume (n=136) and failed (n=212). Compared to failed robotic programs, active programs showed significantly higher leapfrog safety scores (2.9±0.5 vs. 2.1±0.6, p=0.01), were less likely at academic centers (8.3% vs. 23%, p=0.03) and a higher percentage volunteered to report to STS website (31 vs. 40% reporting, Fisher test, P=0.018). However, for those that publically reported, there was no difference in Overall Composite Score (96.2±1.1 vs. 96.6±1.1, P=0.16). There was no difference between groups in the number of hospital beds or the volume of cardiac surgical cases (robotic and non-robotic).
CONCLUSIONS: Implementing robotic cardiac surgery has been challenged over the past decade by many factors. Successful institutions tend to be private facilities with higher performance on safety metrics and more willing to publically report their cardiac surgical outcomes. These factors may relate to the performance culture of the institution.
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