Abstract
Equal access to novel surgical technologies remains a policy concern as hospitals adopt robotic surgery with increasing prevalence. This study sought to determine whether socioeconomic factors influence access to robotic surgery. All laparoscopic and robotic fundoplications and paraesophageal hernia repairs performed by a surgical group over 6 years at a county and two neighboring private hospitals were identified. Robotic use by hospital setting, age, gender, reported ethnicity, estimated income, insurance payer, and diagnosis were examined. Of 418 patients identified, 180 (43%) presented to the county hospital, where subjects were younger (51.1 versus 56.2 years, p < 0.001) with lower estimated income ($50,289 versus $62,959, p < 0.001). In the county setting, there was no difference in reported ethnicity (p = 0.169), estimated income (p = 0.081), or insurance payer (p = 0.535) between groups treated laparoscopically versus robotically. There was no difference in the treatment groups by estimated income in the private hospital setting (p = 0.308). Overall higher estimated income and insurance payer were associated with a higher chance of undergoing robotic procedures (p < 0.001). Presence of a paraesophageal hernia was associated with increased chance of undergoing robotic therapy in all comparisons (p < 0.001). No disparity in access to robotic surgery offered in the county hospital was observed based on age, gender, reported ethnicity, estimated income, or insurance payer. Patients with higher income and private insurers were more likely to present to the private hospital setting where robotics is utilized more often. The presence of a paraesophageal hernia was a significant factor in determining robotic therapy in both settings.
Similar content being viewed by others
References
United Stated Food and Drug Administration (2000) July 2000 510(k) clearances. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/510kClearances/ucm089428.htm. July; Accessed September 20, 2015
Anderson JE, Chang DC, Parsons JK, Talamini MA (2012) The first national examination of outcomes and trends in robotic surgery in the United States. J Am Coll Surg 215:107–114 (discussion 114−106)
Villamere J, Gebhart A, Vu S, Nguyen NT (2015) Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc 29:1729–1736
Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188:19S–26S
Markar SR, Karthikesalingam AP, Hagen ME, Talamini M, Horgan S, Wagner OJ (2010) Robotic vs. laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease: systematic review and meta-analysis. Int J Med Robot 6:125–131
Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363:701–704
Cohen SL, Vitonis AF, Einarsson JI (2014) Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. J Soc Laparoendosc Surg 18(3):pii: e2014.00096. doi:10.4293/JSLS.2014.00096
Davis BR, Yoo AC, Moore M, Gunnarsson C (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. J Soc Laparoendosc Surg 18:211–224
Parsons JK, Messer K, Palazzi K, Stroup SP, Chang D (2014) Diffusion of surgical innovations, patient safety, and minimally invasive radical prostatectomy. JAMA Surg 149:845–851
Trinh QD, Schmitges J, Sun M, Sukumar S, Sammon J, Shariat SF, Jeldres C, Bianchi M, Tian Z, Perrotte P, Rogers CG, Graefen M, Peabody JO, Menon M, Karakiewicz PI (2012) Improvement of racial disparities with respect to the utilization of minimally invasive radical prostatectomy in the United States. Cancer 118:1894–1900
Santry HP, Gillen DL, Lauderdale DS (2005) Trends in bariatric surgical procedures. JAMA 294:1909–1917
United States Census Bureau (2014) United States Census. Available at: http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed September 2014
Mack MJ (2001) Minimally invasive and robotic surgery. JAMA 285:568–572
Blum CA, Adams DB (2011) Who did the first laparoscopic cholecystectomy? J Minim Access Surg 7:165–168
Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17:864–867
Laine S, Rantala A, Gullichsen R, Ovaska J (1997) Laparoscopic vs conventional Nissen fundoplication. A prospective randomized study. Surg Endosc 11:441–444
Heikkinen TJ, Haukipuro K, Bringman S, Ramel S, Sorasto A, Hulkko A (2000) Comparison of laparoscopic and open Nissen fundoplication 2 years after operation. A prospective randomized trial. Surg Endosc 14:1019–1023
Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239:325–337
Salminen P, Hurme S, Ovaska J (2012) Fifteen-year outcome of laparoscopic and open Nissen fundoplication: a randomized clinical trial. Ann Thorac Surg 93:228–233
Nishimura K (2015) Current status of robotic surgery in Japan. Korean J Urol 56:170–178
Berguer R (1999) Surgery and ergonomics. Arch Surg 134:1011–1016
Tarr ME, Brancato SJ, Cunkelman JA, Polcari A, Nutter B, Kenton K (2015) Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. J Minim Invasive Gynecol 22:234–238
Ogden CL, Lamb MM, Carroll MD, Flegal KM (2010) Obesity and socioeconomic status in adults: United States, 2005–2008. NCHS Data Brief 50:1–8
Pampel FC, Denney JT, Krueger PM (2012) Obesity, SES, and economic development: a test of the reversal hypothesis. Soc Sci Med 74:1073–1081
Corley DA, Kubo A (2006) Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol 101:2619–2628
Iovino P, Angrisani L, Tremolaterra F, Nirchio E, Ciannella M, Borrelli V, Sabbatini F, Mazzacca G, Ciacci C (2002) Abnormal esophageal acid exposure is common in morbidly obese patients and improves after a successful Lap-band system implantation. Surg Endosc 16:1631–1635
Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, DeMeester TR, Crookes PF (2009) Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg 13:1440–1447
El-Serag HB (2007) Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 5:17–26
El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880
Acknowledgements
The authors wish to acknowledge Drs. John Mark Bayouth, Daniel Ziegler, and Gerald Robert Stephenson for contributing data, and the Department of Surgery of John Peter Smith Hospital and Baylor University Medical Center for supporting this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. L Tatebe, Ms. Gray, Dr. K Tatebe, and Dr. Putty declare that they have no conflict of interest. Dr. Garcia reports non-financial support from Intuitive Surgical unrelated to the submitted work.
Rights and permissions
About this article
Cite this article
Tatebe, L.C., Gray, R., Tatebe, K. et al. Socioeconomic factors and parity of access to robotic surgery in a county health system. J Robotic Surg 12, 35–41 (2018). https://doi.org/10.1007/s11701-017-0683-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-017-0683-3