ABSTRACT Introduction Transoral robotic surgery (TORS) is increasingly used for oropharyngeal squamous cell carcinoma (OPSCC), yet national patterns of TORS availability for Medicare beneficiaries are not well defined. We characterized hospital type, geographic distribution, and market concentration of TORS. Methods We conducted a retrospective cross‐sectional study of inpatient Medicare claims from 2017 to 2023, identifying OPSCC with ICD‐10‐CM codes and TORS with ICD‐10‐PCS codes including a robotic‐assistance qualifier. Claims were linked to inpatient prospective payment system files for hospital teaching status, disproportionate share hospital (DSH) percentage, urbanicity, and geographic labor market area (GLMA). We mapped county‐level procedure counts, calculated GLMA‐level Herfindahl–Hirschman Index (HHI), and used negative binomial regression to evaluate associations of hospital factors with TORS volume and inpatient length of stay (LOS). Results We identified 2499 unique TORS procedures at 161 hospitals; 86.2% occurred at teaching hospitals, and annual volume rose 31% from 2017 to 2023. TORS use was geographically diffuse but locally concentrated: among 102 GLMAs with any TORS, 64.7% had HHI = 10 000 and 28.4% had HHI 5000–9999. Six GLMAs with > 100 procedures accounted for 33.6% of all cases and were predominantly teaching centers. Higher teaching intensity was associated with greater TORS use (incidence rate ratio IRR: 1.99, 95% CI: 1.63–2.45). LOS was longer in urban and rural hospitals versus metropolitan centers and shorter in high‐volume GLMAs (IRR: 0.82, 95% CI: 0.76–0.87). Conclusion Among Medicare beneficiaries with OPSCC, TORS is concentrated in teaching hospitals and a few high‐volume markets, with shorter LOS in high‐volume regions, highlighting trade‐offs between centralization and access.
Gilmore et al. (Tue,) studied this question.