OBJECTIVES : Robotic surgery has been widely recognized by the medical field due to its advancement in minimally invasive surgical techniques. This retrospective cohort study evaluated the role of hospital-level characteristics in the use of robotic-assisted surgeries in the US pediatric population.

METHODS : Pediatric patients (age ≤ 20) undergoing inpatient procedures were eligible for robotic-assistance were identified in the HCUP Kids’ Inpatient Database (KID) (2016) using ICD-10 procedure codes. Descriptive statistics and the logistic regression models were used to quantify the association between hospital characteristics namely teaching status, location and the likelihood of a child receiving a robotic-assisted surgery. Models adjusted for demographic, clinical, payer and admission characteristics and accounted for the data’s stratified sampling strategy in calculating national estimates.

RESULTS : Of the 42,811 eligible pediatric procedures, only 2.2% utilized robotic assistance. Robotic-assisted surgeries were rare in rural hospitals accounting for only 0.8% of eligible procedures compared to 1.3% in urban non-teaching hospitals (UNTH) and 2.5% in urban teaching hospitals (UTH). Even after adjusting for potentially confounding variables, the odds of receiving a robotic surgery in an UNTH (Odds Ratio [OR] 2.59 (95 % Confidence Interval: 1.26-5.35)) and in UTH (OR: 3.44 (95 % CI 1.74-6.80)) were two to three times as high as in a rural hospital. Bed size was also associated with the likelihood of receiving a robotic-assisted surgery with medium size hospitals more likely to use robots than both smaller and larger hospitals. Notably, ownership type was not statistically associated with robotic surgery use. For example, the odds of robotic surgery in a private not-for-profit hospital was about 5% lower than in government hospitals (OR: 0.95, 95% CI: 0.60-1.51).

CONCLUSIONS : The finding implies the existence of health disparity that the likelihood of a pediatric patient receiving a robotic-assisted surgery was not indiscriminately equal across different hospital characteristics.