Trends in industry payments and volume and distribution of robot-assisted surgeries

Considerable evidence links pharmaceutical industry payments to health providers' over-prescribing behavior. In response, public policies were enacted to mitigate this effect. However, there is limited evidence examining surgical device industry payments and surgeons' utilization of robot-assisted surgeries (RAS). This study assessed the relationship between industry payments to healthcare providers and the usage of RAS.

Using 2015-2020 data from the CMS "Sunshine" Open Payments Database and New York State's (NYS) Statewide hospital discharge databases, we assessed temporal and spatial relationships between industry payments to hospitals and surgeons and volumes of RAS.

During 2015-2020, general surgery robotic device manufacturers paid providers more than $236 M nationwide. The highest proportion of payments was made toward "Education and training" (66.6%) and "Food and travel" (20.6%). In NYS, gastrointestinal (GI) RAS volume steadily increased by 182% (2015-2019, p < 0.01), while there was a 150% increase in general surgeon payments. Genitourinary (GU) and gynecological (GYN) surgeon payments remained unchanged but GU and GYN RAS volume increased by 17% and 75%, respectively, during this period (p < 0.05). Approximately, 93% of payments and 98% of abdomen and pelvic RAS in NYS were concentrated in metropolitan or non-rural counties.

With increasing payments from robotic device companies toward surgeon education and training, the use of RAS is likely to continue to rise in the long term. Unbiased and non-industry-funded studies examining RAS effect on surgeon behavior and patient outcomes are imperative to ensure system efficiency and patient safety.