Robot-associated inpatient hospital activity in Germany, 2019–2025: nationwide trends in coded robot categories and diagnostic case mix

Robot-assisted surgery has spread from urology into several other surgical fields, and different categories of robotic system are now coded separately in Germany. This nationwide descriptive time-series analysis used aggregated hospital data of the Institute for the Hospital Remuneration System for 2019 to 2025. All inpatient hospital cases carrying at least one code of the group for use of a surgical robot (group 5-987 of the German Operation and Procedure Classification) were included, and annual case volume, the coded robot categories, principal diagnoses grouped at the three-character level, sex, age, clinical complexity and length of stay were described, together with selected index procedures counted with and without a robot code. The annual number of cases increased 3.78-fold, from 32,691 in 2019 to 123,706 in 2025, and rose in every year. Prostate cancer remained the most frequent principal diagnosis group: its case number almost doubled from 14,796 to 29,407 while its share fell from 45.3% to 23.8%. Osteoarthritis of knee became the second most frequent, rising from 1,936 to 21,447 cases. The proportion of female cases increased from 26.1% to 40.9%. Among hospital cases with the code for radical prostatovesiculectomy, the proportion also carrying a robot code rose from 52.9% to 85.1%, and for knee endoprosthesis implantation from 1.1% to 8.9%. Recorded robot-associated inpatient hospital activity almost quadrupled over seven years, and both the coded robot categories and the diagnostic composition broadened. These data describe recorded activity and its composition but do not provide information on outcomes, costs or appropriateness.