WSJ: Small hospitals get little benefit from device

In The Wall Street Journal, John Carreyrou uses the problems of a small New Hampshire hospital to illustrate how difficult it is for small hospitals to attain the cost and safety savings promised by the DaVinci surgical device’s manufacturers, a fact which has not deterred 131 of them from shelling out at least $1 million (plus maintenance and replacement fees) to own one.

Photo by stilldavid via Flickr.

“There’s a medical arms race,” says Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston. “Technologies are being adopted and becoming widespread based on the marketing prowess of equipment makers and suppliers, not necessarily on the public good.”

Smaller hospitals, which Carreyrou defines as those with fewer than 200 beds, simply don’t have the volume to gain the DaVinci cost efficiencies promised by manufacturer Intuitive Surgical.

One study published in the Journal of Urology found that a hospital needs to do at least 520 surgeries a year with the robot to bring its costs in line with traditional surgery. That’s seven times the number of robotic surgeries Wentworth-Douglass has been averaging.

And while it’s unfortunate that they don’t even use the device enough to save money, it’s far worse that they also don’t use it often enough to master its steep learning curve. Surgeons at the New Hampshire hospital got two days of training and began operating unassisted after four cases.

Jim Hu, a surgeon at Brigham and Women’s Hospital in Boston who has done more than 1,000 surgeries with the robot, says it takes a urologist anywhere from 250 to 700 cases to master it. Dr. Hu considers the da Vinci a clear benefit for experienced surgeons, saying, “You can do a better job.” But he cautions it can do more harm than good when used without adequate training.

In New Hampshire, the hospital’s four urologists were pressured to use the device, but resisted because they felt more training was needed, Carreyrou writes. Three of them eventually left the hospital.

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