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Uptake and Patient Outcomes of Laparoscopic Colon and Rectal Cancer Surgery in a Publicly Funded System and Following Financial Incentives

Annals of Surgical Oncology volume 20, pages 3740–3746 (2013)Cite this article

Abstract

Purpose

To assess patterns of uptake and outcomes of laparoscopic colon and rectal cancer surgery in Ontario, and the potential influence of surgical fee incentives instituted on October 1, 2005.

Methods

We used Ontario administrative databases from fiscal years 2002 to 2009. Study outcomes were uptake rates of laparoscopic surgery, hospital length of stay, 30-day operative mortality, cancer-specific survival, and overall survival. The main descriptor for multivariable regression models was a 5 % increase in rate of laparoscopic colon cancer surgery in the previous year.

Results

The annual rate of laparoscopic colon and rectal cancer surgery, respectively, rose from 8.7 to 38.9 % and from 4.8 to 19.6 %. The greatest increase in rate of laparoscopic colon surgery occurred shortly after October 1, 2005. For each 5 % increase in rate of laparoscopic surgery, the odds of 30-day mortality was 1.0 [95 % confidence interval (CI) 0.96–1.01, p = 0.264], the hazard of cancer-specific survival was 1.0 (95 % CI 0.97–1.00, p = 0.139), the hazard of overall survival was 1.0 (95 % CI 0.98–1.00, p = 0.051), and length of hospital stay was lower (estimate = −0.10, 95 % CI −0.14 to −0.06, p < 0.001).

Conclusions

In Ontario by the year 2009, 39 % of colon and 20 % of rectal cancer surgery was provided laparoscopically. Increased rates were associated with a minimal decrease in hospital length of stay and no changes in 30-day mortality, cancer-specific survival, or overall survival. Financial incentives were likely responsible for the marked increase in laparoscopic colon cancer surgery observed after October 1, 2005.

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Disclosure

The authors declare no conflict of interest.

Author information

Affiliations

  1. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD & Margherita Cadeddu MD

  2. Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD

  3. Division of General Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Nancy N. Baxter PhD

  4. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Nancy N. Baxter PhD, Rinku Sutradhar PhD, Ning Liu MSc & David Urbach MD

  5. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Nancy N. Baxter PhD

  6. Division of Clinical Decision-making & Health Care, Toronto General Research Institute, Toronto General Hospital, Toronto, ON, Canada

    David Urbach MD

Authors
  1. Marko Simunovic MD
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  2. Nancy N. Baxter PhD
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  3. Rinku Sutradhar PhD
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  4. Ning Liu MSc
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  5. Margherita Cadeddu MD
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  6. David Urbach MD
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Corresponding author

Correspondence to Marko Simunovic MD.

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Simunovic, M., Baxter, N.N., Sutradhar, R. et al. Uptake and Patient Outcomes of Laparoscopic Colon and Rectal Cancer Surgery in a Publicly Funded System and Following Financial Incentives. Ann Surg Oncol 20, 3740–3746 (2013). https://doi.org/10.1245/s10434-013-3123-2

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  • DOI: https://doi.org/10.1245/s10434-013-3123-2

Keywords

  • Hospital Characteristic
  • Hospital Group
  • Laparoscopic Colon
  • Cluster Specific Random Effect
  • Innovation Uptake