Competitive markets tied to use of robotic surgery

Patients treated at hospitals in competitive regional markets are more likely to undergo robotic-assisted surgery, according to a study published online this week in JAMA Surgery. Researchers determined that a hospital's financial status had less to do with use of the technology.

The authors, from Columbia University and Weill Cornell Medical College, examined 221,637 patients at 1,370 hospitals over two years who underwent one of five types of robotic-assisted surgery: radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy or oophorectomy. Growing market competition was associated with increased use of robotic-assisted surgery for all five types of surgery; at the same time, higher profit margins were associated only with partial nephrectomy.

In analysis only of hospitals performing robotic surgery, competition ceased to be a factor in use.

"These data imply that regional competition may influence a hospital's decision to acquire a surgical robot, but once the device is in place, market competition exerts less influence on actual within-hospital use," the authors say. They note that competition might push hospitals to "offer a service of questionable value or potentially lose market share to competitors who choose to offer the service."

They also note that robotic-assisted surgery is associated with substantially higher costs than alternatives, but can be among the technologies driving up costs in competitive markets.

Safety-net hospitals, nonteaching facilities and smaller hospitals were less likely to perform robotic-assisted surgery, the researchers found. And nonwhite women, the uninsured and Medicaid recipients were less likely to undergo robotic-assisted surgery.

One previous study found that facilities were more likely to acquire a surgical robot if neighboring hospitals had one, with the authors warning of a "medical arms race."

Yet, another Columbia study, published in Obstetrics & Gynecology, raised questions about robotic surgery's higher cost and rates of complications.

Meanwhile, rapid growth in the market for medical robots has been predicted.

To learn more:
- here's the study