Surgical Endoscopy

, Volume 32, Issue 3, pp 1556–1563 | Cite as

Predicting opportunities to increase utilization of laparoscopy for rectal cancer

  • Deborah S. Keller
  • Jiejing Qiu
  • Anthony J. Senagore
Article

Abstract

Background

Despite proven safety and efficacy, rates of laparoscopy for rectal cancer in the US are low. With reports of inferiority with laparoscopy compared to open surgery, and movements to develop accredited centers, investigating utilization and predictors of laparoscopy are warranted. Our goal was to evaluate current utilization and identify factors impacting use of laparoscopic surgery for rectal cancer.

Methods

The Premier™ Hospital Database was reviewed for elective inpatient rectal cancer resections (1/1/2010–6/30/2015). Patients were identified by ICD-9-CM diagnosis codes, and then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes or billing charge. Logistic multivariable regression identified variables predictive of laparoscopy. The Cochran–Armitage test assessed trend analysis. The main outcome measures were trends in utilization and factors independently associated with use of laparoscopy.

Results

3336 patients were included—43.8% laparoscopic (n = 1464) and 56.2% open (n = 1872). Use of laparoscopy increased from 37.6 to 55.3% during the study period (p < 0.0001). General surgeons performed the majority of all resections, but colorectal surgeons were more likely to approach rectal cancer laparoscopically (41.31 vs. 36.65%, OR 1.082, 95% CI [0.92, 1.27], p < 0.3363). Higher volume surgeons were more likely to use laparoscopy than low-volume surgeons (OR 3.72, 95% CI [2.64, 5.25], p < 0.0001). Younger patients (OR 1.49, 95% CI [1.03, 2.17], p = 0.036) with minor (OR 2.13, 95% CI [1.45, 3.12], p < 0.0001) or moderate illness severity (OR 1.582, 95% CI [1.08, 2.31], p < 0.0174) were more likely to receive a laparoscopic resection. Teaching hospitals (OR 0.842, 95% CI [0.710, 0.997], p = 0.0463) and hospitals in the Midwest (OR 0.69, 95% CI [0.54, 0.89], p = 0.0044) were less likely to use laparoscopy. Insurance status and hospital size did not impact use.

Conclusions

Laparoscopy for rectal cancer steadily increased over the years examined. Patient, provider, and regional variables exist, with hospital status, geographic location, and colorectal specialization impacting the likelihood. However, surgeon volume had the greatest influence. These results emphasize training and surgeon-specific outcomes to increase utilization and quality in appropriate cases.

Keywords

Laparoscopic colorectal surgery Rectal cancer Surgical quality Surgeon volume 

Notes

Acknowledgements

The authors acknowledge the Medtronic Minimally Invasive Therapies Group for access to the data source and assistance with statistical modeling.

Compliance with ethical standards

Disclosures

Ms. Qiu is employed by Medtronic, which gave access to the data source and assistance with statistical analysis. Drs. Keller and Senagore have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryBaylor University Medical CenterDallasUSA
  2. 2.Healthcare Economics and Outcomes ResearchMedtronicMansfieldUSA
  3. 3.University of Texas Medical Branch at GalvestonGalvestonUSA

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