TY  - BOOK
AU  - Al-Refaie, Waddah B
AU  - Bayasi, Mohammed
AU  - Chan, Kitty
AU  - Houlihan, Brenna K
AU  - Villano, Anthony M
AU  - Zeymo, Alexander
TI  - Minimally Invasive Surgery for Colorectal Cancer: Hospital Type Drives Utilization and Outcomes
SN  - 0022-4804
PY  - 2020///
KW  - *Colorectal Neoplasms/su [Surgery]
KW  - *Laparoscopy/sn [Statistics & Numerical Data]
KW  - *Patient Acceptance of Health Care/sn [Statistics & Numerical Data]
KW  - *Postoperative Complications/ep [Epidemiology]
KW  - *Robotic Surgical Procedures/sn [Statistics & Numerical Data]
KW  - Academic Medical Centers/sn [Statistics & Numerical Data]
KW  - Academic Medical Centers/td [Trends]
KW  - Aged
KW  - Colorectal Neoplasms/pa [Pathology]
KW  - Conversion to Open Surgery/sn [Statistics & Numerical Data]
KW  - Conversion to Open Surgery/td [Trends]
KW  - Databases, Factual/sn [Statistics & Numerical Data]
KW  - Female
KW  - Hospital Mortality
KW  - Hospitals, Community/sn [Statistics & Numerical Data]
KW  - Hospitals, Community/td [Trends]
KW  - Humans
KW  - Laparoscopy/ae [Adverse Effects]
KW  - Laparoscopy/td [Trends]
KW  - Male
KW  - Middle Aged
KW  - Neoplasm Grading
KW  - Postoperative Complications/et [Etiology]
KW  - Robotic Surgical Procedures/td [Trends]
KW  - Treatment Outcome
KW  - United States/ep [Epidemiology]
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Surgery/Colorectal Surgery
KW  - Surgery/General Surgery
KW  - Journal Article
N2  - 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)
UR  - https://dx.doi.org/10.1016/j.jss.2019.07.102
ER  -