Transoral robotic surgery: Differences between online information and academic literature

Objectives: Evaluate the authorship, content, quality, and readability of information on Transoral Robotic Surgery (TORS) available to patients online. Methods: The technical search term "TORS Surgery" and layperson's term "robotic surgery of the mouth" were utilized to conduct a search of the top 50 websites on Google, Bing, and Yahoo. Websites were evaluated according to the HONcode evaluation of content and quality, and readability was assessed using the Flesch Reading Ease Formula, Flesch-Kincaid Grade Level Formula, SMOG readability formula, Coleman Liau Index formula, and Gunning Fog Index. Statistical analysis was conducted using the Fisher Freeman- Halton test to compare differences in authorship, quality, and content between the three search engines and the Fisher exact test was used to determine if there was a difference in these variables between the two search terms. Results: Overall, websites were predominantly from academic institutions with 97% mentioning benefits of TORS with 24% mentioning risks. 45% of TORS websites had no description of the TORS procedure, while 62% allowed individuals to make appointments. There was a significant difference in authorship with the layperson's terms yielding more news sources, but there were no significant differences in quality and content of information elicited through the technical and layperson search terms. The mean readability scores were Flesch Kincaid Grade Level 13.81(+/- 3.32), Gunning-Fog Index 16.51(+/- 3.39), SMOG 12.53(+/- 2.40), and Automated Readability Index 14.05 (+/- 4.17). Conclusions: Current online information on TORS surgery may not provide balanced information for patients to make informed healthcare decisions. The current readability of online information regarding TORS far exceeds the average literacy level of average American adults.