ArticleJournal of robotic surgery2026
Contract architecture and time-to-first public activation of robotic urology programs in Poland: a nationwide open-data linkage study.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Public announcements of robot purchases are often treated as equivalent to new robotic-urology capacity, although procurement disclosure and stable public activity are different milestones. We assessed whether contract architecture helps interpret public activation of robotic urology programs in Poland. We conducted a nationwide open-data linkage study linking the CEZ/NFZ provider-level reimbursement workbook for robotic surgery in Poland (April 2022-June 2025) with auditable Polish da Vinci disclosures (February 2024-March 2026), an exact-PDF subset, and a fixed public Synektik page naming 42 hospitals. First public reimbursement was treated as a proxy for first publicly visible activation. Analyses included segmented diffusion modelling, rolling-origin validation, trajectory clustering, and exploratory contract-architecture clustering. Poland had 56 providers with any public robotic surgery and 53 with public RARP across 14 regions. Median first-month public RARP volume was 6 cases and median first-6-month volume was 54. A segmented Poisson model outperformed a single-trend model (AIC 119.6 vs. 138.1), with the best breakpoint in November 2022 and 24.3% lower rolling-origin predictive deviance. Among 12 urology-linked disclosures, 7 of 11 capital acquisitions occurred at active public RARP sites, 4 were likely de novo public entries, and 1 was a maintenance event. In the exact-PDF subset (n = 8), contract phenotype did not separate likely de novo from already active sites. In a mature public robotic-urology market, procurement notices more often signalled scaling or continuity within the public reimbursement layer than first public activation. Contract data became informative only after linkage to downstream public activity.
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