Market-Level Features May Influence a Hospital's Decision to Perform Robotic Radical Cystectomy in Florida

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Robotic radical cystectomy (RC) adoption preceded evidence of oncologic noninferiority.
• Market-level factors may have influenced the adoption of robotic RC by hospitals.

Purpose of the Study:

• To investigate the association between market-level features and the adoption of robotic radical cystectomy (RC).

Main Methods:

• Analysis of the Florida Inpatient Discharge data set (2013-2020) for patients undergoing RC.
• Comparison of characteristics between facilities performing robotic versus open RC.
• Assessment of market features including hospital operating margin, mean per capita income, and market concentration (Herfindahl-Hirschman index).
• Multivariable logistic and negative binomial regression models were used to evaluate associated features.

Main Results:

• 19% of 4723 patients underwent robotic RC; 47% of 96 hospitals performed at least one robotic RC.
• Increased odds of offering robotic RC were associated with higher mean per capita income (OR, 1.05), positive hospital operating margin (OR, 6.6), and higher average annual cystectomy volume (OR, 9.6).
• Higher hospital size and mean per capita income correlated with a greater number of robotic RCs performed.

Conclusions:

• Local market demand and financial resources, not market competitiveness, influenced robotic RC adoption in Florida.
• Findings offer insights for policymakers examining the adoption patterns of new surgical technologies.