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

Adoption of robotic radical cystectomy (RC) occurred before the availability of randomized data supporting oncologic noninferiority of this approach. We hypothesized that market-level features may have influenced a hospital's likelihood of offering robotic RC.

We used the Florida Inpatient Discharge dataset to identify patients who underwent RC for bladder cancer from 2013 to 2020 and compared characteristics between facilities that performed robotic or only open RC. Market features assessed included hospital operating margin, mean per capita income, and the Herfindahl-Hirschman index-a measure of market concentration. Multivariable logistic and negative binomial regression models were fit to evaluate features associated with robotic RC.

We identified 4723 patients, of whom 891 (19%) underwent robotic RC. Among the 96 hospitals, 45 (47%) performed at least 1 robotic RC. After multivariable adjustment, features associated with increased odds of offering robotic RC were increasing mean per capita income of the health service area (odds ratio [OR], 1.05, 95% CI: 1.0-1.1, P = .04), a positive hospital operating margin (OR, 6.6, 95% CI: 1.0-43, P = .05), and a higher average annual cystectomy volume (OR, 9.6, 95% CI: 2.1-45, P = .004). Increasing hospital size (incidence rate ratio, 1.12, 95% CI: 1.11-1.13) and mean per capita income (incidence rate ratio 1.05, 95% CI: 1.04-1.07) were significantly associated with a higher number of robotic RCs performed (P < .001).

In Florida, local market demand and available financial resources were associated with hospitals offering robotic RC, although market competitiveness was not. These data may be of interest to policymakers investigating adoption patterns of new surgical technology.