Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

J Surg Oncol. 2023 Aug;128(2):375-384. doi: 10.1002/jso.27274. Epub 2023 Apr 10.


Background: Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP.

Study design: The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort.

Results: Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP.

Conclusion: Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

Keywords: Medicaid; healthcare disparities; national cancer database; prostate cancer; robot-assisted radical prostatectomy.

MeSH terms

  • Aged
  • Humans
  • Male
  • Medicare
  • Prostatectomy / adverse effects
  • Prostatic Neoplasms* / surgery
  • Robotic Surgical Procedures* / adverse effects
  • Robotics*
  • Treatment Outcome
  • United States / epidemiology