Minimally Invasive Surgery for Colorectal Cancer: Hospital Type Drives Utilization and Outcomes.

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Citation: Journal of Surgical Research. 247:180-189, 2020 03.PMID: 31753556Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Surgery/Colorectal Surgery | Surgery/General SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Colorectal Neoplasms/su [Surgery] | *Laparoscopy/sn [Statistics & Numerical Data] | *Patient Acceptance of Health Care/sn [Statistics & Numerical Data] | *Postoperative Complications/ep [Epidemiology] | *Robotic Surgical Procedures/sn [Statistics & Numerical Data] | Academic Medical Centers/sn [Statistics & Numerical Data] | Academic Medical Centers/td [Trends] | Aged | Colorectal Neoplasms/pa [Pathology] | Conversion to Open Surgery/sn [Statistics & Numerical Data] | Conversion to Open Surgery/td [Trends] | Databases, Factual/sn [Statistics & Numerical Data] | Female | Hospital Mortality | Hospitals, Community/sn [Statistics & Numerical Data] | Hospitals, Community/td [Trends] | Humans | Laparoscopy/ae [Adverse Effects] | Laparoscopy/td [Trends] | Male | Middle Aged | Neoplasm Grading | Postoperative Complications/et [Etiology] | Robotic Surgical Procedures/td [Trends] | Treatment Outcome | United States/ep [Epidemiology]Year: 2020ISSN:
  • 0022-4804
Name of journal: The Journal of surgical researchAbstract: CONCLUSIONS: MIS for CRC lags at the community level and experiences worse postoperative outcomes. Future initiatives must focus on understanding and correcting this trend to ensure uniform access to high-quality surgical care. Copyright (c) 2019 Elsevier Inc. All rights reserved.INTRODUCTION: Minimally invasive surgery (MIS) for colorectal cancer (CRC) is increasingly common; however, uptake has differed by hospital type. It is unknown how these trends have evolved for laparoscopic or robotic approaches in different types of hospitals. This study assesses temporal trends for MIS utilization and examines differences in surgical outcomes by hospital type.METHODS: The National Cancer Database was queried for patients who underwent CRC surgery between 2010 and 2015. Time-trend analysis of MIS utilization was performed for both approaches by hospital type (community, comprehensive community, integrated network, academic). Multivariate logistic regression models were used to examine MIS utilization, differences in case severity, and surgical outcomes by hospital type, after controlling for patient characteristics.RESULTS: Across all hospital types, community hospitals had the lowest rate of laparoscopic (36.8%) and robotic (3.3%) procedures for CRC (P < 0.001). Community hospitals also exhibited a significant lag in adoption rate of robotic surgery (colon = 0.84% versus 1.41%/y; rectum = 2.14% versus 3.88 %/y). Community hospitals performing MIS had worse outcomes, including the most frequent conversions to open (colon = 15.2%; rectal = 17.1%) and highest 90-day mortality (colon = 6%; rectal = 3.2%) (P < 0.001). Finally, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors (OR 0.938, P < 0.05) with higher 30-day (OR 1.332, P < 0.05) and 90-day mortality (OR 1.210, P < 0.05).All authors: Al-Refaie WB, Bayasi M, Chan KS, Houlihan BK, Villano AM, Zeymo AOriginally published: Journal of Surgical Research. 247:180-189, 2020 Mar.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-02-26
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Journal Article MedStar Authors Catalog Article 31753556 Available 31753556

CONCLUSIONS: MIS for CRC lags at the community level and experiences worse postoperative outcomes. Future initiatives must focus on understanding and correcting this trend to ensure uniform access to high-quality surgical care. Copyright (c) 2019 Elsevier Inc. All rights reserved.

INTRODUCTION: Minimally invasive surgery (MIS) for colorectal cancer (CRC) is increasingly common; however, uptake has differed by hospital type. It is unknown how these trends have evolved for laparoscopic or robotic approaches in different types of hospitals. This study assesses temporal trends for MIS utilization and examines differences in surgical outcomes by hospital type.

METHODS: The National Cancer Database was queried for patients who underwent CRC surgery between 2010 and 2015. Time-trend analysis of MIS utilization was performed for both approaches by hospital type (community, comprehensive community, integrated network, academic). Multivariate logistic regression models were used to examine MIS utilization, differences in case severity, and surgical outcomes by hospital type, after controlling for patient characteristics.

RESULTS: Across all hospital types, community hospitals had the lowest rate of laparoscopic (36.8%) and robotic (3.3%) procedures for CRC (P < 0.001). Community hospitals also exhibited a significant lag in adoption rate of robotic surgery (colon = 0.84% versus 1.41%/y; rectum = 2.14% versus 3.88 %/y). Community hospitals performing MIS had worse outcomes, including the most frequent conversions to open (colon = 15.2%; rectal = 17.1%) and highest 90-day mortality (colon = 6%; rectal = 3.2%) (P < 0.001). Finally, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors (OR 0.938, P < 0.05) with higher 30-day (OR 1.332, P < 0.05) and 90-day mortality (OR 1.210, P < 0.05).

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