Dock the Robot for the Injured Patient: Patterns and Trends of Robotic Surgery Use in Trauma Patients

Background: Robotic surgery (RobSurg) utilization has increased in multiple surgical fields. We aimed to review recent trends of RobSurg use in trauma surgery and hypothesized that the use of RobSurg is increasing and varies across different hospital types. Methods: The 2017-2020 ACS-TQIP database was used to identify all injured patients ≥18 years undergoing RobSurg, defined by robotic ICD-10 procedure codes. We examined the annual trends of RobSurg utilization. We then examined patient demographics, mechanisms of injury, time to surgery, procedures performed, hospital type, outcomes (e.g. mortality, postoperative complications), and conversion to open surgery. Results: Of 4,005,762 trauma patients, 1,391,350 (34.7%) underwent surgical procedures, of which 210 (15/100,000) were robotic. The use of RobSurg has increased from 7.5/100,000 procedures in 2017 to 25.5/100,000 in 2020, P<0.001. The median age was 55 years, 88.6% had a blunt mechanism of injury, 6.7% had gunshot wounds, and 4.8% had stab wounds. RobSurg most commonly involved the lung (17.1%), spine (13.8%), and diaphragm (4.3%). Only 3 (1.4%) patients underwent a non-specific robotic peritoneal exploration for trauma. The median time to surgery was 76 hours (IQR 30-170.2), the rate of conversion to open was 28%, and mortality was 3.3%. Non-teaching hospitals performed RobSurg more frequently than teaching hospitals (19.2/100,000 procedures in non-teaching vs. 10.5/100,000 in teaching hospitals, P<0.001). RobSurg was also more frequent in lower-level trauma centers (12.2/100,000 in level I, 17.6/100,000 in level II, and 22.6/100,000 in level III trauma centers, P=0.04). Conclusion: RobSurg utilization in the trauma setting remains limited but perhaps increasing, especially in non-teaching and level II/III trauma centers, with its use largely restricted to subacute interventions. Further studies are needed to examine the effectiveness of RobSurg compared to open or laparoscopic surgery in injured patients.