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 23 May 2018

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News

Disparities in laparoscopic surgery use among Medicare patients with colon cancer

The latest issue of the Diseases of the Colon & Rectum examines patient, hospital, and geographic disparities in laparoscopic surgery use among surveillance, epidemiology, and end results–Medicare patients with colon cancer.

News image

Surgical resection is the primary treatment for colon cancer, but use of laparoscopic approaches varies widely despite demonstrated short- and long-term benefits.

Dr Mario Schootman and colleagues identified characteristics associated with laparoscopic colon cancer resection, and to quantify variation based on patient, hospital, and geographic characteristics.

The team evaluated patient, surgeon, hospital, and geographic characteristics and unexplained variability using adjusted median odds ratios for hospitals and counties.

The Surveillance, Epidemiology, and End Results–Medicare claims database supplemented with county-level American Community Survey demographic data was used.

47% of patients underwent laparoscopic surgery
Diseases of the Colon & Rectum

The team included a total of 10,618 patients ≥66 years old who underwent colon cancer resection.

The researcher's main outcomes were nonurgent/nonemergent resections for colon cancer patients ≥66 years old were classified as laparoscopic or open procedures.

Patients resided in 579 counties and used 950 hospitals.

The team noted that 47% of patients underwent laparoscopic surgery.

Medicare/Medicaid dual enrollment, age ≥85 years, and higher tumor stage and grade were negatively associated with laparoscopic surgery receipt.

Proximal tumors and increasing hospital size and surgeon caseload were positively associated.

The researchers observed that significant unexplained variability at the hospital and county levels remained after adjustment.

Dr Schootman's team concludes, "Determining sources of hospital-level variation among poor insured patients may help increase laparoscopic resection to maximize health outcomes and reduce cost."

Dis Colon Rectum 2017: 60(9): 905–913
17 October 2017

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