Evidence map›Paper›PMID 41556601›Full record

ArticleHead & neck2026

Geographic and Institutional Patterns of Transoral Robotic Surgery in Head and Neck Cancer.

Daniel Gilmore, Lauren R Michelle, Xiaodan Hu, Stephen Y Kang, Nolan B Seim, Catherine T Haring, Matthew O Old, Amit Agrawal, Enver Ozer, Lauren E Miller

Abstract read
In one paragraph

Article in Head & neck, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Daniel GilmoreThe Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA.
Lauren R MichelleDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Xiaodan HuThe Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA.
Stephen Y KangDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Nolan B SeimDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Catherine T HaringDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.ORCID 0000-0002-9317-6536
Matthew O OldDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Amit AgrawalDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Enver OzerDepartment of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Lauren E MillerThe Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA.ORCID 0000-0002-5458-0544

Funding

AHRQ HHS T32 HS029590NIH HHS 1T32HS029590‐01
6 · The paper itself

Abstract

introductionTransoral robotic surgery (TORS) is increasingly used for oropharyngeal squamous cell carcinoma (OPSCC), yet national patterns of TORS availability for Medicare beneficiaries are not well defined. We characterized hospital type, geographic distribution, and market concentration of TORS.

methodsWe conducted a retrospective cross-sectional study of inpatient Medicare claims from 2017 to 2023, identifying OPSCC with ICD-10-CM codes and TORS with ICD-10-PCS codes including a robotic-assistance qualifier. Claims were linked to inpatient prospective payment system files for hospital teaching status, disproportionate share hospital (DSH) percentage, urbanicity, and geographic labor market area (GLMA). We mapped county-level procedure counts, calculated GLMA-level Herfindahl-Hirschman Index (HHI), and used negative binomial regression to evaluate associations of hospital factors with TORS volume and inpatient length of stay (LOS).

resultsWe identified 2499 unique TORS procedures at 161 hospitals; 86.2% occurred at teaching hospitals, and annual volume rose 31% from 2017 to 2023. TORS use was geographically diffuse but locally concentrated: among 102 GLMAs with any TORS, 64.7% had HHI = 10 000 and 28.4% had HHI 5000-9999. Six GLMAs with > 100 procedures accounted for 33.6% of all cases and were predominantly teaching centers. Higher teaching intensity was associated with greater TORS use (incidence rate ratio [IRR]: 1.99, 95% CI: 1.63-2.45). LOS was longer in urban and rural hospitals versus metropolitan centers and shorter in high-volume GLMAs (IRR: 0.82, 95% CI: 0.76-0.87).

conclusionAmong Medicare beneficiaries with OPSCC, TORS is concentrated in teaching hospitals and a few high-volume markets, with shorter LOS in high-volume regions, highlighting trade-offs between centralization and access.

Indexed as

Head and Neck NeoplasmsNatural Orifice Endoscopic SurgeryRobotic Surgical ProceduresSquamous Cell Carcinoma of Head and NeckAgedCross-Sectional StudiesFemaleHospitals, TeachingHumansLength of StayMaleMedicareRetrospective StudiesUnited States

Identifiers

PMID41556601
PMCPMC13155175

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.