Background: Despite the widespread adoption of minimally invasive surgery in the U.S., disparities in its use persist. One unexplored contributor is geographic access to robotic surgical systems. This study evaluates the geospatial association between: (i) social vulnerability index (SVI) and open surgery rates, (ii) availability of robotic systems and open surgery, and (iii) open surgery rates in demographically similar areas with differing robotic access. Study Design: Data from six sources were linked at the ZIP Code Tract Area (ZCTA) level to identify hospitals and extract procedure modality, presence of robotic systems, and area characteristics. Regression analysis assessed the association between SVI and open surgery rates. Open rates were then compared between hospitals with and without robotic systems. Propensity score matching was used to compare open rates across matched ZCTAs by robotic access and SVI levels. Results: Higher social vulnerability was associated with increased open surgery rates (estimate = 0.20; p < 0.01), with rates ranging from 18.3% in low-vulnerability areas to 32.7% in high-vulnerability areas. Among 3,446 eligible ZCTAs, 57% had at least one robotic system. ZCTAs without robotic systems had higher open surgery rates (42.9 vs. 19.4 per 100 procedures; relative rate = 2.21; p < 0.01). This association remained significant after matching (relative rate = 1.66; p < 0.01), for the low-mid- and high-SVI strata, and three of the five procedures examined Conclusion: When correcting for geographic variation, the availability of robotic surgery was associated with a decrease in open surgery rates.
Fong et al. (Mon,) studied this question.