Presentation (CTI)

OBJECTIVES: In the last decade, numerous studies have documented inequities in access to minimally invasive surgery (MIS) amongst patient groups when compared to open surgery. The introduction of robotic assisted surgery (RAS) has increased the rates of MIS, but it is unknown how this introduction has impacted existing access disparities. Therefore the objective of this study was to assess how the introduction of RAS has impacted access disparities to MIS amongst under-served patient groups for common general surgery (CGS) procedures.
METHODS: Adult patients undergoing CGS procedures (cholecystectomy, inguinal hernia repair, ventral hernia repair, and colorectal resection) from 2016 to 2022 were identified using the PINC AI™ Healthcare Database. Hospitals associated with these patient encounters were characterized by those that did and did not have RAS capabilities. RAS capability was determined by having at least one CGS procedure conducted by RAS; the index date for these hospitals was the date of first RAS CGS procedure. For both hospital types, changes in access disparity were measured comparing pre- and post-index date MIS rates across age, sex, race/ethnicity and payor type. Each model had a time-by-demographic interaction term to assess whether disparities changed over time.
RESULTS: Among the 408 hospitals, 153 (38%) hospitals introduced RAS while 255 (62%) hospitals did not. Access disparities were seen to decrease across sex, age, and race in hospitals that introduced RAS, but no reduction in MIS access disparities were seen in hospitals that did not introduce RAS. This decrease in disparities in RAS hospitals but not in non-RAS hospitals indicated that RAS introduction was associated with reduced MIS access disparities.
CONCLUSIONS: Although disparities across demographic characteristics persist, the narrowing of their magnitude underscores the importance of emerging technology that better enables MIS in expanding access to such approaches in underserved groups.