Association Between Surgical Robotic Availability and Open Operation Rate: A Geographic Analysis

Area of Science:

• Health Services Research
• Surgical Technology
• Geographic Health Disparities

Background:

• Minimally invasive surgery adoption varies across the U.S., with persistent disparities.
• Geographic access to robotic surgical systems is an understudied factor in these disparities.
• Social vulnerability and robotic system availability may influence surgical approach selection.

Purpose of the Study:

• To evaluate the geospatial association between social vulnerability index (SVI) and open surgery rates.
• To assess the relationship between robotic system availability and open surgery rates.
• To compare open surgery rates in demographically similar areas with differing robotic access.

Main Methods:

• Data from six sources were linked at the ZIP Code Tract Area (ZCTA) level.
• Regression analysis assessed the association between SVI and open surgery rates.
• Propensity score matching compared open rates across matched ZCTAs by robotic access and SVI levels.

Main Results:

• Higher SVI correlated with increased open surgery rates (18.3% low vs. 32.7% high vulnerability).
• ZCTAs without robotic systems had significantly higher open surgery rates (42.9 vs. 19.4 per 100 procedures).
• This association persisted after matching for SVI and robotic access.

Conclusions:

• Robotic surgery availability is linked to decreased open surgery rates when accounting for geographic variation.
• Addressing geographic disparities in robotic system access may reduce open surgery rates.
• Findings underscore the importance of equitable access to advanced surgical technologies.