OBJECTIVE: To identify factors associated with utilization of robotic surgical technology, especially those leading to increased disparities in care access.
METHODS: The AHA Annual Survey and HCUP SID from California for 2006-2011 were linked. Patients undergoing thyroidectomy, lung lobectomy, hepatectomy, colectomy, rectal resection, hysterectomy, cystectomy, nephrectomy, or prostatectomy for cancer were included. Logistical models were used to identify patient and hospital characteristics associated with utilization or adoption of robotic surgical technology.
RESULTS: 477 925 patients at 416 hospitals were included. 21 451 (4.5%) underwent a robotic procedure. After controlling for covariates, patients were more likely to receive robotic surgery if privately insured (OR: 2.22, 95% C.I.: 2.14-2.30) and less likely if female (OR: 0.21, 95% C.I.:0.20-0.22). Hospital factors that increased odds of robotic adoption included a highly privately insured patient population (OR 2.36, 95% C.I.: 1.28-3.33) and Commission on Cancer Hospital status (OR 5.37, 96% C.I.: 2.39-12.07). Joint Commission status and teaching hospital status were not associated with adoption of robotic surgical technology. Disparities in race and payer status were less significant for lung lobectomy and hepatectomy than for procedures performed on a single sex.
CONCLUSION: Variation in adoption of robotic surgical practices exists, and is strongly associated with a heavily privately insured patient population. As more information about outcomes of robotic procedures materializes, efforts to minimize disparities in access to optimal surgical care are needed.