Disparities in robot utilization in colorectal surgery: the widening gap

BACKGROUND: Robot-assisted surgery has expanded in adoption and indication among multiple surgical specialties, including colorectal surgery. It is unclear if access to robotic surgery is increasing equally among all patient populations. OBJECTIVE: (1) Identify the factors that may influence type of surgical approach and (2) evaluate disparities in access and subsequent outcomes of colectomy and proctectomy from years 2013-2020 using a national database. STUDY DESIGN: We performed a retrospective study using the National Surgical Quality Improvement Program to identify adult patients who had undergone colectomy and/or proctectomy from years 2013-2020. We performed multivariate analysis to identify factors that may influence the likelihood of receiving robotic surgery. SETTINGS: Tertiary care medical center. PATIENTS: 18 years and older, received colectomy and/or proctectomy from 2013-2020. MAIN OUTCOME MEASURES: Frequency of robotic colorectal surgery, postoperative complications, and mortality. RESULTS: A total of 125,776 patients met inclusion criteria. Mean age was 61.4 years; 12.8% (16,086) of patients were non-White. In multivariate analysis, patients who were female, non-White, underweight or had inflammatory bowel disease were less likely to undergo robot-assisted surgery (p < 0.05). Although the total number of robotic cases increased year-to-year, the gap between White and non-White patients widened. In 2014, a White patient was 1.51 times more likely to have robot-assisted surgery compared to a non-White patient; odds increased to 1.96 in 2020 (p < 0.001). Patients who underwent robot-assisted surgery were less likely to have a postoperative complication (OR 0.86, CI 0.82-0.9) or serious adverse event (OR 0.9, CI 0.84-0.97), and had lower odds of 30-day mortality (OR 0.72, CI 0.57-0.91). LIMITATIONS: Retrospective, limited coding in national databases, and database variables. CONCLUSIONS: Despite increased awareness of racial and ethnic disparities in surgical care, non-White patients' decreased access to robot-assisted surgery is troublesome. Interventions must focus on closing this gap if we are to provide equitable healthcare.