Availability of Robotic Surgery Linked to Population Concentration

The first robotic surgery on record was performed in 1985 when a robotic arm was used to take a brain biopsy. In the 30-plus years since, robotic surgical systems have evolved from computer-assisted models to modern controller-controlled robotic systems that replicate the surgeon’s exact movements through robotic instruments working on a patient. Robotic surgery has become a viable option in neurological, urological, gynecological, cardiothoracic, and many other general surgical procedures. The benefits of robotic surgery for patients include cutting precision and miniaturization. These two characteristics lead to shorter hospitalizations, reduced pain and discomfort, faster recovery time, smaller incisions, lower infection rates, fewer readmissions, reduced blood loss, and minimal scarring.1 Studies on the long term effects of robotic surgery compared to traditional open cavity surgery don’t appear to exist. However, the technology has enabled certain procedures to occur at ambulatory surgical centers. In many cases, that can mean an overnight hospital stay is no longer required for recovery. Technological innovation in health care is an important driver of cost growth. Robotic systems have high fixed costs – equipment prices range from $1-$2.5 million per unit.2 In the case of procedures that had previously been performed as open surgery, some of the new costs are offset by reductions in post-operative costs (no overnight stay) and by productivity gains when patients recover more rapidly and can return to work and their lives sooner. While faster recovery is possible with robotic surgery, it comes at a higher cost because of the technology’s fixed costs. Figure 1 (see below) shows the distribution of robotic surgery done in ambulatory surgery centers around the state between 2015 and 2016. Due to high fixed costs, robotic systems need to be operating several times daily to recoup up-front expenses. It is not surprising then that the availability of robot-assisted surgery is primarily available in urban areas where population and commercial insurance are more prevalent. The majority of patients receiving robotic surgery are between the ages of 35 and 59 (mainly working adults). (1/12)
1 https://robotenomics.com/2014/06/05/the-cost-effectiveness-and-advantages-of-robotic-surgery/
2 Ibid.