Geographic and Institutional Variation in the Adoption of Robotic Technologies in Spinal Fusion Surgeries Across the United States from 2011 to 2021

Introduction: Robotic technology enhances precision in spinal fusion surgeries, potentially improving patient outcomes. However, its adoption may vary geographically and by hospital setting, influencing equitable access to advanced care. This study analyzes the adoption of robotic spinal fusion technologies across U.S. Census divisions from 2011 to 2021, incorporating hospital location and teaching status.

Methods: Data from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) from 2011 to 2021 was analyzed to assess trends in robotic spinal fusion adoption. Relevant ICD-9 and ICD-10 codes identified robotic procedures. Adoption rates were calculated as the proportion of robotic to total spinal fusions. National adoption rates for 2011 and 2016 were reviewed to assess early trends, with a primary focus on 2017 to 2021 growth across divisions. Average annual adoption rates were calculated for each division and stratified by hospital classification (Urban Teaching, Urban Non-Teaching, Rural).

Results: From 2011 to 2021, 34,896 robotic spinal fusion surgeries were performed nationally, with a marked increase beginning in 2017. Urban teaching hospitals led adoption consistently across divisions. Urban non-teaching hospitals showed selective regional growth, particularly in New England (3.90%) and East South Central (1.78%). Rural hospitals lagged, with limited uptake, highlighting barriers to integration in these settings.
Between 2017 and 2021, the highest average annual adoption rates were observed in the New England (3.90%) and South Atlantic (1.93%) divisions, while the West North Central and Mountain divisions remained low at approximately 0.69% and 0.91%. New England saw the greatest increase, from 0.98% in 2017 to 5.96% in 2021.

Conclusion : Robotic spinal fusion adoption has increased significantly since 2011, particularly after 2017, with substantial growth in urban teaching and some urban non-teaching hospitals. Rural adoption remains sparse, highlighting geographic and institutional disparities in technology access. Further investigation into these disparities may support broader integration of robotic technology.