Logo image
Back
Patient, Hospital, and Geographic Disparities in Laparoscopic Surgery Use Among Surveillance, Epidemiology, and End Results-Medicare Patients With Colon Cancer
Journal article   Open access   Peer reviewed

Patient, Hospital, and Geographic Disparities in Laparoscopic Surgery Use Among Surveillance, Epidemiology, and End Results-Medicare Patients With Colon Cancer

Kendra L. Ratnapradipa, Min Lian, Donna B. Jeffe, Nicholas O. Davidson, Jan M. Eberth, Sandi L. Pruitt and Mario Schootman
Diseases of the colon & rectum, v 60(9), pp 905-913
Sep 2017
DOI: https://doi.org/10.1097/DCR.0000000000000874
PMID: 28796728
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc5643006?pdf=renderView
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Gastroenterology & Hepatology Life Sciences & Biomedicine Science & Technology Surgery
BACKGROUND: Surgical resection is the primary treatment for colon cancer, but use of laparoscopic approaches varies widely despite demonstrated short- and long-term benefits. OBJECTIVE: The purpose of this study was to identify characteristics associated with laparoscopic colon cancer resection and to quantify variation based on patient, hospital, and geographic characteristics. DESIGN: Bayesian cross-classified, multilevel logistic models calculated adjusted ORs and CIs for patient, surgeon, hospital, and geographic characteristics and unexplained variability (predicted vs. observed values) using adjusted median odds ratios for hospitals and counties. SETTINGS: The Surveillance, Epidemiology, and End Results-Medicare claims database (2008-2011) supplemented with county-level American Community Survey (2008-2012) demographic data was used. PATIENTS: A total of 10,618 patients >= 66 years old who underwent colon cancer resection were included. MAIN OUTCOME MEASURES: Nonurgent/nonemergent resections for colon cancer patients >= 66 years old were classified as laparoscopic or open procedures. RESULTS: Patients resided in 579 counties and used 950 hospitals; 47% of patients underwent laparoscopic surgery. Medicare/Medicaid dual enrollment, age >= 85 years, and higher tumor stage and grade were negatively associated with laparoscopic surgery receipt; proximal tumors and increasing hospital size and surgeon caseload were positively associated. Significant unexplained variability at the hospital (adjusted median OR = 3.31; p < 0.001) and county levels (adjusted median OR = 1.28; p < 0.05) remained after adjustment. LIMITATIONS: This was an observational study lacking generalizability to younger patients without Medicare or those with Health Maintenance Organization coverage and data set did not reflect national hospital studies or hospital volume. In addition, we were unable to account for specific types of comorbidities, such as obesity, and had broad categories for surgeon caseload. CONCLUSIONS: Determining sources of hospital-level variation among poor insured patients may help increase laparoscopic resection to maximize health outcomes and reduce cost. See Video Abstract at http://links.lww.com/DCR/A363.

Metrics

9 Record Views
32 citations in Web of Science
31 citations in Scopus

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Gastroenterology & Hepatology
Surgery
Logo image