Geographic and Socioeconomic Disparities in Robotic Spine Surgery Access in the Continental United States: A Cross-Sectional Ecological Analysis

Abstract

Study Design Cross-sectional ecological analysis. Objectives This study aims to assess the availability of robotic spine surgery across the United States and identify 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 P < .05 level. Results Ninety-one robotic spine surgeons were identified. Robotic spine surgeons were predominantly 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 < .001). Factors increasing the odds of being a hotspot include higher disability prevalence (OR = 1.19, P < .001), lack of insurance (OR = 1.18, P < .001), and older median age (OR = 1.17, P < .001). Educational attainment and ADI, despite being significant, had lower predictive values for access. Conclusions Disparities in access to robotic spine surgery are associated with socioeconomic, demographic, and geographic factors. The concentration of surgeons in nonteaching hospitals and higher-income areas may reflect market dynamics. Efforts to improve access should consider regional resources, hospital type, and community disadvantage.