In today's competitive environment, hospitals increasingly market their services on the Internet and patients often turn to hospital websites to learn about treatment options. While serious deficiencies have been documented in the educational value of direct-to-consumer drug advertising, a similar analysis has not been performed for advertisement of a hospital service. Patients increasingly search the Internet for reliable information on state-of-the-art care (Hartzband & Groopman, 2010; Johnson, Chen, Eng, Makary, & Fishman, 2008; Wald, Dube, & Anthony, 2007), and often consider information provided on a hospital website as trustworthy. Although there are few regulations governing what hospitals can report regarding the quality of care on their website, many patients consider content on a hospital website to be a physician's voice (Pronovost, Miller, & Wachter, 2007). However, we postulate that some hospital websites are overestimating the benefits and underestimating the risks associated with the use of expensive technologies. Robotic surgery is one service that has been the focus of significant advertising efforts from both hospitals and manufacturers. Use of robotic surgery in the United States has increased 400% over the last 4 years (Intuitive Surgical Inc., 2010a, 2010b [Intuitive Surgical 2010b, Investor Report 2010 Quarter 1]), despite limited evidence demonstrating benefit. Seven of the eight randomized-control trials in general surgery procedures show no patient benefit from this new technology (Baik et al., 2008; Cadiere et al., 2001; Draaisma et al., 2006; Morino, Pelligrino, Giaccone, Garrone, & Rebecchi, 2006; Morino et al., 2004; Muller-Stich et al., 2007; Muller-Stich et al., 2009; Nakadi et al., 2006; Sanchez et al., 2005), with one unblinded study demonstrating a decreased length of stay (Baik et al., 2008). One of the largest comparative effectiveness reviews of robotic surgery to date, including 111 studies, concluded that robotic surgery was “unproven with potential” pending further long term, controlled studies (Institute for Clinical and Economic Review, 2009). Meanwhile, robotic surgery costs significantly more than standard laparoscopic surgery, including a capital cost of up to US$2.3 million per robot, a service contract of up to US$180,000 per year, and a disposable parts cost of up to US$2,200 per operation (Intuitive Surgical Inc., 2010a, 2010b). The use of the robot adds on average US$3,200 to the overall cost per procedure (Barbash & Glied, 2010). Even with increased costs and no clear evidence of superiority, robotic surgery has become an important marketing tool for hospitals in attracting patients and generating revenue (Carreyrou, 2010; Intuitive Surgical Inc., 2010a [Hospital Resources-Broad Economic Impact] 2010b; Kolata, 2010).
As information provided on hospital websites can have significant influence on patient choice in treatment, it is important to ensure that the information presented is not misleading. Our study aimed to characterize the nature of hospital website marketing of robotic surgery by analyzing the prevalence, prominence, and content of robotic surgery information on hospital websites.