Receipt of Industry Payments and Surgeons' Adoption of Robotic-Assisted Surgery

The use of robotic-assisted surgery has increased rapidly despite limited evidence of superior outcomes over more established surgical approaches such as laparoscopy.

To evaluate whether and to what extent surgeons' financial relationships with industry are associated with the use of robotic-assisted surgery.

In this cohort study, fee-for-service Medicare claims (January 1, 2011, to December 31, 2021) for patients undergoing 1 of 4 common surgical operations (bariatric surgery, cholecystectomy, colectomy, or ventral hernia repair) were linked to surgeon-level Open Payments data on receipt of industry payments from a large robotic surgical device company. Data were analyzed from April to August 2025.

Receipt of a direct industry payment from a robotic-assisted surgical device company.

Each surgeon's use of robotic-assisted surgery as a proportion of all surgeries performed by that surgeon. A staggered difference-in-differences (DID) approach was used to isolate the association of industry payments with the proportional use of robotic-assisted surgery among surgeons who received payment compared with control surgeons who never received a payment.

Among 20 313 surgeons (mean [SD] age, 50.7 [10.2] years; 86.2% male) performing 886 385 surgeries, 5933 (29.2%) received at least 1 industry payment. Receipt of an industry payment was associated with a significant increase in the proportional use of robotic-assisted surgery, with a DID estimate of 9.9 percentage points (pp) (95% CI, 9.30-10.6 pp). Results were consistent across discrete procedures (eg, DID estimate of 11.7 pp [95% CI, 9.4-13.9 pp] for bariatric surgery and 10.3 pp [95% CI, 9.4-11.4 pp] for ventral hernia repair). There was a significant dose-dependent response. For example, surgeons receiving less than $500 increased use of robotic-assisted surgery after payment from a mean of 1.5% (95% CI, 1.4%-1.6%) to 3.7% (95% CI, 3.5%-3.9%), compared with 0.4% (95% CI, 0.4%-0.5%) to 17.0% (95% CI, 16.7%-17.3%) among surgeons receiving more than $10 000.

In this cohort study, receipt of industry payments by surgeons was associated with increased use of robotic-assisted surgery compared with no receipt of payment, with a significant dose-dependent response. These results suggest that surgeon-industry financial relationships may be an important contributor to greater use of robotic-assisted surgery across the US.