Factors Influencing Robotic Surgery Adoption in the United States.

INTRODUCTION: Robotic surgery has expanded rapidly in the United States despite high financial commitments of a robotic surgery program. Factors that drive uneven robotic surgery adoption has not been adequately explored at the populational level. METHODS: A retrospective analysis was performed using the National Cancer Database to evaluate facility-level adoption of robotic colorectal surgery. Facilities were stratified by the timing of the first robotic colorectal case into adoption quartiles (1st: earliest to 4th: latest) and nonadopters. A multivariable ordinal logistic regression model with mixed-methods approach with clustering at the facility level was performed to evaluate the association between the timing of robotic surgery adoption and region, institution-type, and patient socioeconomic demographic variables. RESULTS: A total of 1182 facilities were identified as robotic surgery adopters between 2010 and 2021. Early adopting facilities were more likely to be academic facilities (OR 0.34, 95% CI: 0.24-0.47) that treated high-income patients (OR 0.81, 95% CI: 0.70-0.94) with access to insurance (OR 0.71, 95% CI: 0.61-0.81). Early adopting facilities were less likely to treat patients from urban (OR 1.41, 95% CI: 1.18-1.69) and rural regions (OR 1.34, 95% CI: 1.01-1.78) compared to metropolitan areas. CONCLUSIONS: Robotic colorectal surgery adoption is influenced by academic status of the facility and socioeconomic make-up of patients treated at the facility. Ensuring equitable access to advanced surgical technology remains an essential systems-level priority to reduce differences in surgical care delivery.