Association of Index Adopter Characteristics With Peer Surgeon Adoption of Robotic Bariatric Surgery

Robotic surgery adoption in bariatric surgery has expanded rapidly, yet whether early adopter performance influences subsequent peer adoption remains unknown.

To examine the association between index adopter performance characteristics and peer surgeon adoption of robotic bariatric surgery.

Retrospective cohort study using the Michigan Bariatric Surgery Collaborative, a statewide quality improvement registry. Adults undergoing primary laparoscopic or robotic bariatric surgery between 2006 and 2025 were included. Peer surgeons were non-index surgeons at robotic-program sites, each assigned to their earliest robotic site.

Index adopter characteristics: high surgical volume, low complication rate, fast learning curve, and a composite quality indicator.

Primary outcome was peer surgeon adoption of robotic surgery. Analyses included multivariable logistic regression with sensitivity analyses using propensity score matching, inverse probability weighting, and causal forest methods.

The cohort included 87,068 procedures by 121 surgeons at 41 hospitals. Among 106 peer surgeons, 50 (47.2%) adopted robotics (median, 1730 days; IQR, 652-2543). High-volume index adopters were associated with lower peer adoption (adjusted OR, 0.30; 95% CI, 0.09-0.84; P = .03), confirmed by inverse probability weighting (OR, 0.37; P = .04) and causal forest analysis (ATE, - 0.26; P = .02). Results were directionally consistent across all 7 approaches.

High-volume index adopter performance was associated with lower peer adoption, consistent with a crowding-out hypothesis. Promoting technology diffusion may require focusing on equitable robotic resource access rather than peer influence from high-performing early adopters.