Top

Published in:

01-01-2014

National disparities in laparoscopic colorectal procedures for colon cancer

Authors: Monirah AlNasser, Eric B. Schneider, Susan L. Gearhart, Elizabeth C. Wick, Sandy H. Fang, Adil H. Haider, Jonathan E. Efron

Published in: Surgical Endoscopy | Issue 1/2014

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.

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 57:218–235PubMed

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 27:59–83PubMedCrossRef

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 153:1681–1688PubMedCrossRef

Polite BN, Dignam JJ, Olopade OI (2006) Colorectal cancer model of health disparities: understanding mortality differences in minority populations. J Clin Oncol 24:2179–2187PubMedCrossRef

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 15:193–199PubMedCrossRef

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 14:215–221PubMedCrossRef

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 86:582–586PubMedCrossRef

Govindarajan R, Shah RV, Erkman LG, Hutchins LF (2003) Racial differences in the outcome of patients with colorectal carcinoma. Cancer 97:493–498PubMedCrossRef

Cooper GS, Koroukian SM (2004) Racial disparities in the use of and indications for colorectal procedures in Medicare beneficiaries. Cancer 100:418–424PubMedCrossRef

10.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96PubMedCrossRef

11.

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 162:1985–1993PubMedCrossRef

12.

Chien C, Morimoto LM, Tom J, Li CI (2005) Differences in colorectal carcinoma stage and survival by race and ethnicity. Cancer 104:629–639PubMedCrossRef

13.

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 90:1746–1754PubMedCrossRef

14.

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 100:515–523PubMedCrossRef

15.

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 6:283–285PubMed

16.

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 21:413–420PubMedCrossRef

17.

Dimou A, Syrigos KN, Saif MW (2009) Disparities in colorectal cancer in African-Americans vs whites: before and after diagnosis. World J Gastroenterol 15:3734–3743PubMedCrossRef

18.

Sabounchi S, Keihanian S, Anand BS (2012) Impact of race on colorectal cancer. Clin Colorectal Cancer 11:66–70PubMedCrossRef

19.

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 94:1160–1167PubMedCrossRef

20.

Boring CC, Squires TS, Health CW Jr (1992) Cancer statistics for African-Americans. CA Cancer J Clin 42:7–17PubMedCrossRef

21.

Wexner SD, Reissman P, Pfeifer J, Bernstein M, Geron N (1996) Laparoscopic colorectal surgery: analysis of 140 cases. Surg Endosc 10:133–136PubMedCrossRef

22.

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 9:1179–1183PubMedCrossRef

23.

Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD (1997) Laparoscopic colorectal surgery: Do we get faster? Surg Endosc 11:331–335PubMedCrossRef

24.

Gupta A, Watson DI (2001) Effect of laparoscopy on immune function. Br J Surg 88:1296–1306PubMedCrossRef

25.

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 236:759–766PubMedCrossRef

26.

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 45:1070–1077PubMedCrossRef

27.

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 41:901–909PubMedCrossRef

28.

Bruch HP, Schiedeck TH, Schwandner O (1999) Laparoscopic colorectal surgery: a five-year experience. Dig Surg 16:45–54PubMedCrossRef

29.

Healthcare Cost and Utilization Project (HCUP). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 10 Jan 2012

30.

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 230:404–411PubMedCrossRef

31.

Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef

32.

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 6:477–484PubMedCrossRef

33.

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 365:1718–1726PubMedCrossRef

34.

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 246:655–662PubMedCrossRef

35.

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–S20PubMedCrossRef

36.

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 12:583–591PubMedCrossRef

37.

Kemp JA, Finlayson SR (2008) Outcomes of laparoscopic and open colectomy: a national population-based comparison. Surg Innov 15:277–283PubMedCrossRef

38.

Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179–1186PubMedCrossRef

39.

Card D, Dobkin C, Maestas N (2008) The impact of nearly universal insurance coverage on health care utilization: evidence from Medicare. Am Econ Rev 98:2242–2258PubMedCentralPubMedCrossRef

40.

McGillicuddy EA, Schuster KM, Davis KA, Longo WE (2009) Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg 44:1157–1162CrossRef

41.

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 18:1412–1418PubMedCrossRef

Title: National disparities in laparoscopic colorectal procedures for colon cancer
Authors: Monirah AlNasser
Eric B. Schneider
Susan L. Gearhart
Elizabeth C. Wick
Sandy H. Fang
Adil H. Haider
Jonathan E. Efron
Publication date: 01-01-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 1/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3160-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

National disparities in laparoscopic colorectal procedures for colon cancer

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Thoracoscopic hepatectomy for malignant liver tumor

Preface to Guidelines: Laparoscopic treatment of ventral and incisional hernias by the International Endohernia Society (IEHS)

Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia

Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study

Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by overstitch: a preclinical study

The feasibility of delivering a duodenal–jejunal bypass liner (endobarrier) endoscopically with patients under conscious sedation