Minimally Invasive Surgery for Colorectal Cancer: Hospital Type Drives Utilization and Outcomes.
Minimally Invasive Surgery for Colorectal Cancer: Hospital Type Drives Utilization and Outcomes.
- 2020
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).
English
0022-4804
10.1016/j.jss.2019.07.102 [doi] S0022-4804(19)30745-0 [pii]
*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]
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Colorectal Surgery
Surgery/General Surgery
Journal Article
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).
English
0022-4804
10.1016/j.jss.2019.07.102 [doi] S0022-4804(19)30745-0 [pii]
*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]
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Colorectal Surgery
Surgery/General Surgery
Journal Article