Neda Qosja, Aaron C Spaulding, Dorin T Colibaseanu, Andrew J Zganjar, Shalmali R Borkar, Ram A Pathak, Timothy D Lyon
INTRODUCTION: Adoption of robotic radical cystectomy (RC) occurred prior to the availability of randomized data supporting oncologic non-inferiority of this approach. We hypothesized that market level features may have influenced a hospital's likelihood of offering robotic RC.
METHODS: We utilized the Florida Inpatient Discharge Dataset to identify patients who underwent RC for bladder cancer from 2013-2020 and compared characteristics between facilities that performed robotic or only open RC. Market features assessed included hospital operating margin, mean per capita income, and the Herfindahl-Hirschman index, a measure of market concentration. Multivariable logistic and negative binomial regression models were fit to evaluate features associated with robotic RC.
RESULTS: We identified 4,723 patients, of whom 891 (19%) underwent robotic RC. Among the 96 hospitals, 45 (47%) performed at least one robotic RC. Following multivariable adjustment, features associated with increased odds of offering robotic RC were increasing mean per capita income of the health service area (OR 1.05 95% CI: 1.0-1.1, =0.04), a positive hospital operating margin (OR 6.6, 95% CI: 1.0-43, p=0.05), and higher average annual cystectomy volume (OR 9.6, 95% CI: 2.1-45, =0.004). Increasing hospital size (IRR 1.12, 95% CI: 1.11-1.13) and mean per capita income (IRR 1.05, 95% CI: 1.04-1.07) were significantly associated with a higher number of robotic RC performed (p<0.001).
CONCLUSION: In Florida, local market demand and available financial resources were associated with hospitals offering robotic RC, although market competitiveness was not. These data may be of interest to policymakers investigating adoption patterns of new surgical technology.
