Geography, insurance, hospital type impacted use of laparoscopic surgery for colorectal cancer
The prevalence of laparoscopic surgery to treat colorectal cancer varied based on geographical location, hospital type and patient insurance status, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Baltimore.
Researchers collected data on 14,502 patients treated for colorectal cancer from the Healthcare Cost and Utilization Project: Nationwide Inpatient Sample. The cohort included 9,811 patients who received open and 4,691 who underwent laparoscopic procedures.
Laparoscopic surgeries did not vary significantly according to race, with 32.4% of Caucasians, 30.04% of African-Americans, 33.99% of Hispanics and 35.12% of Asian-Pacific Islanders within the cohort undergoing those procedures (P≤.08).
Those with private insurance were significantly more likely to undergo laparoscopic surgery than patients on Medicare or Medicaid or the uninsured among Caucasians (37.4% with private insurance vs. 30.81% on Medicare, 24.92% on Medicaid and 20.47% of the uninsured) and African-Americans (36.92% vs. 28.85% on Medicare, 17.47% on Medicaid and 20.22% of the uninsured). Among Hispanic patients, Medicare recipients were most likely to receive laparoscopic surgery (38.49% compared with 37.42% with private insurance, 20.49% with Medicaid and 16.67% of the uninsured) (P<.001 for all).
Regardless of race, the likelihood of undergoing laparoscopic surgery was greater among patients treated at teaching hospitals (OR=1.37; 95% CI, 1.27-1.47) than nonteaching facilities. Laparoscopic procedures also were more common at urban facilities compared with rural hospitals (OR=2.25, 1.97-2.57). Investigators noted greater odds of receiving laparoscopic surgery in the southern United States (OR=1.15; 95% CI, 1.07-1.24) and reduced odds in the Midwest (OR=0.87; 95% CI, 0.80-0.96) compared with the East and West.
“Nearly one-third of all colon cancer operations are laparoscopically performed,” the researchers wrote. “Race does not appear to play a significant role in the selection of the laparoscopic approach for colon cancer. However, there are significant differences in the selection of laparoscopy for colon cancer patients based on insurance status, geographic location and hospital type.”
For more information:
Nasser MA. S072: National Disparities in Laparoscopic Procedures for Colon Cancer. Presented at: the Society of American Gastrointestinal and Endoscopic Surgeons 2013 Annual Meeting; April 17-20, Baltimore.