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Analysis shows most patients undergoing robotic surgery are rich white men

por Lauren Dubinsky, Senior Reporter | July 05, 2016
Rad Oncology Population Health
What about minorities, women
and those with low income?
Wealthy, white men are the most likely candidates for robotic surgery and minorities, women and those with lower incomes are left with fewer surgical options, according to an analysis from Mount Sinai Beth Israel Hospital. The analysis involved robotic surgery case data on 63,725 patients from 2009 to 2014.

"The reasons behind this phenomenon are multi-factorial," Mark Finkelstein, one of the researchers and research assistant at Icahn School of Medicine at Mount Sinai, told HCB News. "Certainly limitations in access to surgeons that provide robotic assisted care seem to play a role."

Finkelstein believes that this may go hand-in-hand with the current trend toward centralizing care to major hospital centers, while the referral networks remain very much the same. That means that wealthy, white men have better access to the referral networks that give them access to robotic-assisted care.

"We believe that the solution will come with increased centralization," he said. "As more care becomes centralized/regionalized we will likely see more equitable care."

Only certain hospitals and facilities will become referral centers and all patients will eventually be directed to these select facilities. That would ideally provide equal care to all patients according to internal guidelines, said Finkelstein.

Other studies have also shown the disparities that exist in access to robotic surgery. Particularly, people with higher socioeconomic status were more likely to undergo nephron-sparing surgery instead of radical prostatectomy.

The researchers also found that the quality of the robotic surgery cases for each category rose during that time frame, but that it was asymmetric. The cases decreased among urologists and gynecologists, but increased for other specialists including orthopedic surgeons, otolaryngologists, cardiothoracic surgeons and general surgeons.

The researchers believe that the decline in urologists and gynecologists performing robotic surgery is because those specialties were the first to adopt it and most likely experienced more "sub-specialization" during the study period.

Some urologists and gynecologists have chosen to only focus on robotic surgery, and general urologists and gynecology are forgoing it and leaving it to the sub-specialists.

Finkelstein believes that these findings have "significant implications" for surgeons planning for a future practice and hospital administrators who are trying to adapt to the changes in the industry. The study will be presented at the Society of Laparoendoscopic Surgeons' Minimally Invasive Surgery Week 2016 annual meeting at the end of August.

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