In Reply We appreciate the interest of Matulewicz and Meeks in our work. The objective of our analysis was to examine the association between regional market competition and hospital financial status regarding 5 common urologic and gynecologic procedures. For all of the procedures, we noted a strong association between increased market competition and the performance of robotic-assisted surgery. Importantly, we did not analyze the effectiveness of these procedures but sought only to explore potential nonmedical factors that drove the diffusion of the interventions.
Wright JD, Hershman DL. Do Surgeons or Does Hospital Economics Ultimately Decide Operative Approach?—Reply. JAMA Surg. 2016;151(9):884. doi:10.1001/jamasurg.2016.0835