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Predicting opportunities to increase utilization of laparoscopy for colon cancer

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Abstract

Background

Despite proven safety and efficacy, rates of minimally invasive approaches for colon cancer remain low in the USA. Given the known benefits, investigating the root causes of underutilization and methods to increase laparoscopy is warranted. Our goal was to develop a predictive model of factors impacting use of laparoscopic surgery for colon cancer.

Methods

The Premier Hospital Database was reviewed for elective colorectal resections for colon cancer (2009–2014). Patients were identified by ICD-9-CM diagnosis code and then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes. An adjusted multivariate logistic regression model identified variables predictive of use of laparoscopy for colon cancer.

Results

A total of 24,245 patients were included–12,523 (52 %) laparoscopic and 11,722 (48 %) open. General surgeons performed the majority of all procedures (77.99 % open, 71.60 % laparoscopic). Overall use of laparoscopy increased from 48.94 to 52.03 % over the study period (p < 0.0001). Patients with private insurance were more likely to have laparoscopy compared with Medicare patients (adjusted odds ratio (OR) 1.089, 95 % CI [1.004, 1.181], p = 0.0388). Higher volume of surgeons (OR 3.518, 95 % CI [2.796, 4.428], p < 0.0001) and larger hospitals by bed size were more likely to approach colon cancer laparoscopically. Colorectal surgeons were 32 % more likely to approach a case laparoscopically than general surgeons (OR 1.315, 95 % CI [1.222, 1.415], p < 0.0001). Teaching hospitals, hospitals in the Midwest, and hospitals with less than 500 beds were less likely to use laparoscopy.

Conclusions

There are patient, provider, and hospital characteristics that can be identified preoperatively to predict who will undergo surgery for colon cancer using laparoscopy. However, additional patients may be eligible for laparoscopy based on patient-level characteristics. These results have implications for regionalization and increasing teaching of MIS. Recognizing and addressing these variables with training and recruiting could increase use of minimally invasive approaches, with the associated clinical and financial benefits.

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Acknowledgments

The authors acknowledge Medtronic Minimally Invasive Surgical Therapies group for supporting the data source and analysis.

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Authors and Affiliations

  1. Baylor University Medical Center, 3500 Gaston Street, R-1013, Dallas, 75246, TX, USA

    Deborah S. Keller

  2. Healthcare Outcomes Research, Medtronic Minimally Invasive Surgical Therapies, Mansfield, MA, USA

    Niraj Parikh

  3. Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Anthony J. Senagore

Authors
  1. Deborah S. Keller
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  2. Niraj Parikh
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  3. Anthony J. Senagore
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Corresponding author

Correspondence to Deborah S. Keller.

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Disclosures

Dr. Keller has no conflict of interest, Mr. Parikh is an employee of Medtronic, Inc., in the Medtronic Minimally Invasive Surgical Therapies group at the time of the analysis, and Dr. Senagore was in the Advisory board consulting fees from Ethicon Endosurgery.

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Keller, D.S., Parikh, N. & Senagore, A.J. Predicting opportunities to increase utilization of laparoscopy for colon cancer. Surg Endosc 31, 1855–1862 (2017). https://doi.org/10.1007/s00464-016-5185-2

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  • DOI: https://doi.org/10.1007/s00464-016-5185-2

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