Abstract
Introduction
Racial disparity in the treatment of colorectal cancer (CRC) has been cited as a potential cause for differences in mortality. This study compares the rates of laparoscopy according to race, insurance status, geographic location, and hospital size.
Methods
The 2009 Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) database was queried to identify patients with the diagnosis of CRC by the International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariate logistic regression was performed to look at age, gender, insurance coverage, academic versus nonacademic affiliated institutions, rural versus urban settings, location, and proportional differences in laparoscopic procedures according to race.
Results
A total of 14,502 patients were identified; 4,691 (32.35 %) underwent laparoscopic colorectal procedures and 9,811 (67.65 %) underwent open procedures. The proportion of laparoscopic procedures did not differ significantly by race: Caucasian 32.4 %, African-American 30.04 %, Hispanic 33.99 %, and Asian-Pacific Islander 35.12 (P = 0.08). Among Caucasian and African-American patients, those covered by private insurers were more likely to undergo laparoscopic procedures compared to other insurance types (P ≤ 0.001). The odds of receiving laparoscopic procedure at teaching hospitals was 1.39 times greater than in nonteaching hospitals (95 % confidence interval [CI] 1.29–1.48) and did not differ across race groups. Patients in urban hospitals demonstrated higher odds of laparoscopic surgery (2.24, 95 % CI 1.96–2.56) than in rural hospitals; this relationship was consistent within races. The odds of undergoing laparoscopic surgeries was lowest in the Midwest region (0.89, 95 % CI 0.81–0.97) but higher in the Southern region (1.14, 95 % CI 1.06–1.22) compared with the other regions.
Conclusions
Nearly one-third of all CRC surgeries are laparoscopic. Race does not appear to play a significant role in the selection of a laparoscopic CRC operation. However, there are significant differences in the selection of laparoscopy for CRC patients based on insurance status, geographic location, and hospital type.
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References
Lillie-Blanton M, Brodie M, Rowland D, Altman D, McIntosh M (2000) Race, ethnicity, and the health care system: public perceptions and experiences. Med Care Res Rev 57:218–235
Berry J, Bumpers K, Ogunlade V, Glover R, Davis S, Counts-Spriggs M, Kauh J, Flowers C (2009) Examining racial disparities in colorectal cancer care. J Psychosoc Oncol 27:59–83
Akerley WL 3rd, Moritz TE, Ryan LS, Henderson WG, Zacharski LR (1993) Racial comparison of outcomes of male department of Veterans affairs patients with lung and colon cancer. Arch Intern Med 153:1681–1688
Polite BN, Dignam JJ, Olopade OI (2006) Colorectal cancer model of health disparities: understanding mortality differences in minority populations. J Clin Oncol 24:2179–2187
Rogers SO, Ray WA, Smalley WE (2004) A population-based study of survival among elderly persons diagnosed with colorectal cancer: does race matter if all are insured? (United States). Cancer Causes Control 15:193–199
Demissie K, Oluwole OO, Balasubramanian BA, Osinubi OO, August D, Rhoads GG (2004) Racial differences in the treatment of colorectal cancer: a comparison of surgical and radiation therapy between Whites and Blacks. Ann Epidemiol 14:215–221
Cooper GS, Yuan Z, Landefeld CS, Rimm AA (1996) Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health 86:582–586
Govindarajan R, Shah RV, Erkman LG, Hutchins LF (2003) Racial differences in the outcome of patients with colorectal carcinoma. Cancer 97:493–498
Cooper GS, Koroukian SM (2004) Racial disparities in the use of and indications for colorectal procedures in Medicare beneficiaries. Cancer 100:418–424
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96
Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK (2002) Cancer survival among US whites and minorities: a SEER (surveillance, epidemiology, and end results) program population-based study. Arch Intern Med 162:1985–1993
Chien C, Morimoto LM, Tom J, Li CI (2005) Differences in colorectal carcinoma stage and survival by race and ethnicity. Cancer 104:629–639
Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP (2000) Effects of health insurance and race on colorectal cancer treatments and outcomes. Am J Public Health 90:1746–1754
Agrawal S, Bhupinderjit A, Bhutani MS, Boardman L, Nguyen C, Romero Y, Srinivasan R, Figueroa-Moseley C, Committee of Minority Affairs and Cultural Diversity, American College of Gastroenterology (2005) Colorectal cancer in African-Americans. Am J Gastroenterol 100:515–523
Cooper GS, Yuan Z, Rimm AA (1997) Racial disparity in the incidence and case-fatality of colorectal cancer: analysis of 329 United States counties. Cancer Epidemiol Biomarkers Prev 6:283–285
Dignam JJ, Ye Y, Colangelo L, Smith R, Mamounas EP, Wieand HS, Wolmark N (2003) Prognosis after rectal cancer in blacks and whites participating in adjuvant therapy randomized trials. J Clin Oncol 21:413–420
Dimou A, Syrigos KN, Saif MW (2009) Disparities in colorectal cancer in African-Americans vs whites: before and after diagnosis. World J Gastroenterol 15:3734–3743
Sabounchi S, Keihanian S, Anand BS (2012) Impact of race on colorectal cancer. Clin Colorectal Cancer 11:66–70
McCollum AD, Catalano PJ, Haller DG, Mayer RJ, Macdonald JS, Benson AB 3rd, Fuchs CS (2002) Outcomes and toxicity in African-American and Caucasian patients in a randomized adjuvant chemotherapy trial for colon cancer. J Natl Cancer Inst 94:1160–1167
Boring CC, Squires TS, Health CW Jr (1992) Cancer statistics for African-Americans. CA Cancer J Clin 42:7–17
Wexner SD, Reissman P, Pfeifer J, Bernstein M, Geron N (1996) Laparoscopic colorectal surgery: analysis of 140 cases. Surg Endosc 10:133–136
Wishner JD, Baker JW Jr, Hoffman GC, Hubbard GW 2nd, Gould RJ, Wohlgemuth SD, Ruffin WK, Melick CF (1995) Laparoscopic-assisted colectomy: the learning curve. Surg Endosc 9:1179–1183
Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD (1997) Laparoscopic colorectal surgery: Do we get faster? Surg Endosc 11:331–335
Gupta A, Watson DI (2001) Effect of laparoscopy on immune function. Br J Surg 88:1296–1306
Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766
Braga M, Vignali A, Zuliani W, Radaelli G, Gianotti L, Martani C, Toussoun G, Di Carlo V (2002) Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial. Dis Colon Rectum 45:1070–1077
Hewitt PM, Ip SM, Kwok SP, Somers SS, Li K, Leung KL, Lau WY, Li AK (1998) Laparoscopic-assisted versus open surgery for colorectal cancer: comparative study of immune effects. Dis Colon Rectum 41:901–909
Bruch HP, Schiedeck TH, Schwandner O (1999) Laparoscopic colorectal surgery: a five-year experience. Dig Surg 16:45–54
Healthcare Cost and Utilization Project (HCUP). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 10 Jan 2012
Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, Bender JS, Duncan MD, Magnuson TH, Lillemoe KD, Cameron JL (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 230:404–411
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Veldkamp R, Kuhry E, Hop WC et al (2005) Colon cancer laparoscopic or open resection study group (COLOR): laparoscopic surgery versus open surgery for colon cancer—short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726
Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study group trial. Ann Surg 246:655–662
Pitiakoudis M, Michailidis L, Zezos P, Kouklakis G, Simopoulos C (2011) Quality training in laparoscopic colorectal surgery: Does it improve clinical outcome? Tech Coloproctol 15:S17–S20
Steele SR, Brown TA, Rush RM, Martin MJ (2008) Laparoscopic versus open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 12:583–591
Kemp JA, Finlayson SR (2008) Outcomes of laparoscopic and open colectomy: a national population-based comparison. Surg Innov 15:277–283
Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179–1186
Card D, Dobkin C, Maestas N (2008) The impact of nearly universal insurance coverage on health care utilization: evidence from Medicare. Am Econ Rev 98:2242–2258
McGillicuddy EA, Schuster KM, Davis KA, Longo WE (2009) Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg 44:1157–1162
Robinson CN, Chen GJ, Balentine CJ, Sansgiry S, Marshall CL, Anaya DA, Artinyan A, Albo D, Berger DH (2011) Minimally invasive surgery is underutilized for colon cancer. Ann Surg Oncol 18:1412–1418
Disclosures
This is an original work by Monirah AlNasser, Eric B. Schneider, Susan L. Gearhart, Elizabeth C. Wick, Sandy H. Fang, Adil H. Haider, and Jonathan Efron who have no conflict of interest or financial ties to disclose.
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AlNasser, M., Schneider, E.B., Gearhart, S.L. et al. National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 28, 49–57 (2014). https://doi.org/10.1007/s00464-013-3160-8
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DOI: https://doi.org/10.1007/s00464-013-3160-8