Geospatial Analysis of Access to Robotic Spine Surgery in the Continental United States

Introduction: Robotic-assisted spine surgery has significantly improved surgical precision and outcomes. This study builds on existing literature by examining geospatial disparities in access to robotic spine surgery. The aims of this study are to: 1) analyze the current access to robotic spine surgery across the United States, 2) identify the types of medical centers affiliated with robotic spine surgeons, and 3) highlight disparities in access.

Methods: We utilized provider-finding functions from major medical equipment manufacturers to identify robotic spine surgeons and categorized affiliated hospitals. Geospatial analyses combined with socioeconomic indicators, Rural-Urban Continuum Codes, and the Area Deprivation Index (ADI) provided insights into access disparities. Multivariate logistic regression and Student’s t-tests were used to identify county-level variables associated with hotspots and coldspots. Statistical significance was set at the 0.05 level.

Results: Ninety-one robotic spine surgeons were identified. Robotic spine surgeons were pre-dominantly affiliated with nonteaching hospitals (50.55%), followed by minor teaching (38.46%) and major teaching (10.99%) hospitals. Access hotspots are in the Northeast and Southeast, with rural areas showing 22% lower odds of being hotspots (OR=0.78, P < 0.001). Factors increasing the odds of being a hotspot include higher disability prevalence (OR=1.19, P < 0.001), lack of insurance (OR=1.18, P < 0.001), and older median age (OR=1.17, P < 0.001). Educational attainment and ADI, despite being significant, had lower predictive values for access.

Conclusion : The predominance of surgeons in nonteaching hospitals and affluent areas highlights market forces in healthcare access. Addressing economic hurdles and demonstrating cost-effectiveness of robotic surgery are crucial for broader access.