Impact of the Dissemination of Surgical Technology on Cancer Surgery Outcomes

University Of Michigan At Ann Arbor, Ann Arbor MI

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Abstract

PROJECT SUMMARY The dissemination of new technology is a major driver of spending growth for cancer care. New biological agents, imaging tests, and devices are among the many sectors of technology that play a disproportionate role in health expenditures. However, equally important and under- recognized is the dissemination of new surgical procedures. Many new surgical technologies, such as robotics, are more expensive than procedures they replace, at least in terms of spending related to the index hospitalization. Nonetheless, these procedures hold the promise of improved outcomes for patients, including reduced pain, blood loss, and hospitalization requirements. New surgical technologies are attractive to cancer patients because of these potential immediate benefits. However, the population effects of minimally invasive technologies on patients undergoing major cancer surgery on outcomes beyond those related to the initial hospitalization are unclear. Nearly one in seven patients undergoing major surgery is readmitted within one month, resulting in more than $17 billion per year in excess spending. For cancer patients, readmissions after surgery are disruptive, can delay needed adjuvant therapy, and diminish quality of life. Using national Medicare data, we will identify the impact of the dissemination of new surgical technology on readmissions and spending after major cancer surgery. We hypothesize that the adoption of new surgical technology will reduce postoperative complications and thereby reduce readmissions. By reducing complications and also minimizing the use of home care and other post-acute care services, we hypothesize that minimally invasive surgical technology will also result in lower episode spending. The results of this study will enhance our understanding of the population effects of the diffusion of novel technology on these two important endpoints. These findings will inform future efforts to evaluate the value of technological advances and improve the surgical care of cancer patients. With the continued focus on value in healthcare, this information will be essential to policymakers and clinical leaders to make decisions regarding the dissemination of new technologies, whose broader benefits may not be fully appreciated by analyses narrowly assessing the index hospitalization.