JAMA Netw Open. 2026 Mar 2;9(3):e263885. doi: 10.1001/jamanetworkopen.2026.3885.
ABSTRACT
IMPORTANCE: The use of robotic-assisted surgery has increased rapidly despite limited evidence of superior outcomes over more established surgical approaches such as laparoscopy.
OBJECTIVE: To evaluate whether and to what extent surgeons’ financial relationships with industry are associated with the use of robotic-assisted surgery.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, fee-for-service Medicare claims (January 1, 2011, to December 31, 2021) for patients undergoing 1 of 4 common surgical operations (bariatric surgery, cholecystectomy, colectomy, or ventral hernia repair) were linked to surgeon-level Open Payments data on receipt of industry payments from a large robotic surgical device company. Data were analyzed from April to August 2025.
EXPOSURE: Receipt of a direct industry payment from a robotic-assisted surgical device company.
MAIN OUTCOME AND MEASURES: Each surgeon’s use of robotic-assisted surgery as a proportion of all surgeries performed by that surgeon. A staggered difference-in-differences (DID) approach was used to isolate the association of industry payments with the proportional use of robotic-assisted surgery among surgeons who received payment compared with control surgeons who never received a payment.
RESULTS: Among 20 313 surgeons (mean [SD] age, 50.7 [10.2] years; 86.2% male) performing 886 385 surgeries, 5933 (29.2%) received at least 1 industry payment. Receipt of an industry payment was associated with a significant increase in the proportional use of robotic-assisted surgery, with a DID estimate of 9.9 percentage points (pp) (95% CI, 9.30-10.6 pp). Results were consistent across discrete procedures (eg, DID estimate of 11.7 pp [95% CI, 9.4-13.9 pp] for bariatric surgery and 10.3 pp [95% CI, 9.4-11.4 pp] for ventral hernia repair). There was a significant dose-dependent response. For example, surgeons receiving less than $500 increased use of robotic-assisted surgery after payment from a mean of 1.5% (95% CI, 1.4%-1.6%) to 3.7% (95% CI, 3.5%-3.9%), compared with 0.4% (95% CI, 0.4%-0.5%) to 17.0% (95% CI, 16.7%-17.3%) among surgeons receiving more than $10 000.
CONCLUSIONS AND RELEVANCE: In this cohort study, receipt of industry payments by surgeons was associated with increased use of robotic-assisted surgery compared with no receipt of payment, with a significant dose-dependent response. These results suggest that surgeon-industry financial relationships may be an important contributor to greater use of robotic-assisted surgery across the US.
PMID:41910972 | DOI:10.1001/jamanetworkopen.2026.3885
