Proficiency-based training and credentialing can improve patient outcomes and decrease cost to a hospital system

Background: While proficiency-based robotic training has been shown to enhance skill acquisition, no studies have shown that training leads to improved outcomes or quality measures. Methods: Board-certified general surgeons participated in an optional proficiency-based robotic training curriculum and outcomes from robotic hernia cases were analyzed. Multivariable analysis was performed for operative times to adjust for patient and surgical variables. Results: Six out of 16 (38%) surgeons completed training and 210 robotic hernia cases were analyzed. Longer operative times were associated with bilateral repairs (observed-to-expected operative time ratio [OTR] = 1.41, p < 0.001) and incarceration (OTR = 1.24, p = 0.006), while female patients (OTR = 0.87, p = 0.001) and increasing chronologic case order (OTR = 0.94, p < 0.001) were associated with shorter operative times. Surgeons who completed robotic training achieved shorter OTRs than those who did not (p = 0.03). Comparing non-risk adjusted hospital costs, trainees had an average of $1207 in savings (20% reduction) per robotic hernia case. Conclusions: A structured proficiency-based robotics training curriculum is an effective way to reduce operative times and costs.