title: Disparities in access to hospitals with robotic surgery for patients with prostate cancer undergoing radical prostatectomy.
abstract: OBJECTIVE
  We described population level trends in radical prostatectomy for patients with prostate cancer by hospitals with robotic surgery, and assessed whether socioeconomic disparities exist in access to such hospitals.
  
  
  METHODS
  After merging the NIS (Nationwide Inpatient Sample) and the AHA (American Hospital Association) survey from 2006 to 2008, we identified 29,837 patients with prostate cancer who underwent radical prostatectomy. The primary outcome was treatment with radical prostatectomy at hospitals that have adopted robotic surgery. Multivariate logistic regression was used to identify patient and hospital characteristics associated with radical prostatectomy performed at hospitals with robotic surgery.
  
  
  RESULTS
  Overall 20,424 (68.5%) patients were surgically treated with radical prostatectomy at hospitals with robotic surgery, while 9,413 (31.5%) underwent radical prostatectomy at hospitals without robotic surgery. There was a marked increase in radical prostatectomy at hospital adopters from 55.8% in 2006 and 70.7% in 2007 to 76.1% in 2008 (p <0.001 for trend). After adjusting for patient and hospital features, lower odds of undergoing radical prostatectomy at hospitals with robotic surgery were seen in black patients (OR 0.81, p <0.001) and Hispanic patients (OR 0.77, p <0.001) vs white patients. Compared to having private health insurance, being primarily insured with Medicaid (OR 0.70, p <0.001) was also associated with lower odds of being treated at hospitals with robotic surgery.
  
  
  CONCLUSIONS
  Although there was a rapid shift of patients who underwent radical prostatectomy to hospitals with robotic surgery from 2006 to 2008, black and Hispanic patients or those primarily insured by Medicaid were less likely to undergo radical prostatectomy at such hospitals.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA. simkim@me.com
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.forename: Leona C
authors.initials: LC
authors.lastname: Han
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: James P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
mesh_terms: D000368:Aged; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics