Utilization of Minimally Invasive Surgery in Endometrial Cancer Care: A Quality and Cost Disparity
To describe case mix-adjusted hospital level utilization of minimally invasive surgery for hysterectomy in the treatment of early-stage endometrial cancer. In this retrospective cohort study, we analyzed the proportion of patients who had a minimally invasive compared with open hysterectomy for nonm...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2016-01, Vol.127 (1), p.91-100 |
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| creator | Fader, Amanda N. Weise, R. Matsuno Sinno, Abdulrahman K. Tanner, Edward J. Borah, Bijan J. Moriarty, James P. Bristow, Robert E. Makary, Martin A. Pronovost, Peter J. Hutfless, Susan Dowdy, Sean C. |
| description | To describe case mix-adjusted hospital level utilization of minimally invasive surgery for hysterectomy in the treatment of early-stage endometrial cancer.
In this retrospective cohort study, we analyzed the proportion of patients who had a minimally invasive compared with open hysterectomy for nonmetastatic endometrial cancer using the U.S. Nationwide Inpatient Sample database, 2007-2011. Hospitals were stratified by endometrial cancer case volumes (low=less than 10; medium=11-30; high=greater than 30 cases). Hierarchical logistic regression models were used to evaluate hospital and patient variables associated with minimally invasive utilization, complications, and costs.
Overall, 32,560 patients were identified; 33.6% underwent a minimally invasive hysterectomy with an increase of 22.0-50.8% from 2007 to 2011. Low-volume cancer centers demonstrated the lowest minimally invasive utilization rate (23.6%; P |
| doi_str_mv | 10.1097/AOG.0000000000001180 |
| format | Article |
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In this retrospective cohort study, we analyzed the proportion of patients who had a minimally invasive compared with open hysterectomy for nonmetastatic endometrial cancer using the U.S. Nationwide Inpatient Sample database, 2007-2011. Hospitals were stratified by endometrial cancer case volumes (low=less than 10; medium=11-30; high=greater than 30 cases). Hierarchical logistic regression models were used to evaluate hospital and patient variables associated with minimally invasive utilization, complications, and costs.
Overall, 32,560 patients were identified; 33.6% underwent a minimally invasive hysterectomy with an increase of 22.0-50.8% from 2007 to 2011. Low-volume cancer centers demonstrated the lowest minimally invasive utilization rate (23.6%; P<.001). After multivariable adjustment, minimally invasive surgery was less likely to be performed in patients with Medicaid compared with private insurance (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.62-0.72), black and Hispanic compared with white patients (adjusted OR 0.43, 95% CI 0.41-0.46 for black and 0.77, 95% CI 0.72-0.82 for white patients), and more likely to be performed in high- compared with low-volume hospitals (adjusted OR 4.22, 95% CI 2.15-8.27). Open hysterectomy was associated with a higher risk of surgical site infection (adjusted OR 6.21, 95% CI 5.11-7.54) and venous thromboembolism (adjusted OR 3.65, 95% CI 3.12-4.27). Surgical cases with complications had higher mean hospitalization costs for all hysterectomy procedure types (P<.001).
Hospital utilization of minimally invasive surgery for the treatment of endometrial cancer varies considerably in the United States, representing a disparity in the quality and cost of surgical care delivered nationwide.</description><identifier>ISSN: 0029-7844</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/AOG.0000000000001180</identifier><identifier>PMID: 26646127</identifier><language>eng</language><publisher>United States: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</publisher><subject><![CDATA[African Americans - statistics & numerical data ; Aged ; Endometrial Neoplasms - surgery ; European Continental Ancestry Group - statistics & numerical data ; Female ; Hispanic Americans - statistics & numerical data ; Hospitalization - economics ; Hospitals, High-Volume - standards ; Hospitals, High-Volume - statistics & numerical data ; Hospitals, Low-Volume - standards ; Hospitals, Low-Volume - statistics & numerical data ; Humans ; Hysterectomy - economics ; Hysterectomy - methods ; Hysterectomy - standards ; Medicaid - statistics & numerical data ; Middle Aged ; Minimally Invasive Surgical Procedures - economics ; Minimally Invasive Surgical Procedures - statistics & numerical data ; Minimally Invasive Surgical Procedures - trends ; Retrospective Studies ; Robotic Surgical Procedures - economics ; Robotic Surgical Procedures - statistics & numerical data ; Robotic Surgical Procedures - trends ; Surgical Wound Infection - etiology ; United States ; Venous Thromboembolism - etiology]]></subject><ispartof>Obstetrics and gynecology (New York. 1953), 2016-01, Vol.127 (1), p.91-100</ispartof><rights>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3014-fb393c2619aa2bb877fb4865b596f0c4239b1753108ab874a07c7c851b3a44153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26646127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fader, Amanda N.</creatorcontrib><creatorcontrib>Weise, R. Matsuno</creatorcontrib><creatorcontrib>Sinno, Abdulrahman K.</creatorcontrib><creatorcontrib>Tanner, Edward J.</creatorcontrib><creatorcontrib>Borah, Bijan J.</creatorcontrib><creatorcontrib>Moriarty, James P.</creatorcontrib><creatorcontrib>Bristow, Robert E.</creatorcontrib><creatorcontrib>Makary, Martin A.</creatorcontrib><creatorcontrib>Pronovost, Peter J.</creatorcontrib><creatorcontrib>Hutfless, Susan</creatorcontrib><creatorcontrib>Dowdy, Sean C.</creatorcontrib><title>Utilization of Minimally Invasive Surgery in Endometrial Cancer Care: A Quality and Cost Disparity</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>To describe case mix-adjusted hospital level utilization of minimally invasive surgery for hysterectomy in the treatment of early-stage endometrial cancer.
In this retrospective cohort study, we analyzed the proportion of patients who had a minimally invasive compared with open hysterectomy for nonmetastatic endometrial cancer using the U.S. Nationwide Inpatient Sample database, 2007-2011. Hospitals were stratified by endometrial cancer case volumes (low=less than 10; medium=11-30; high=greater than 30 cases). Hierarchical logistic regression models were used to evaluate hospital and patient variables associated with minimally invasive utilization, complications, and costs.
Overall, 32,560 patients were identified; 33.6% underwent a minimally invasive hysterectomy with an increase of 22.0-50.8% from 2007 to 2011. Low-volume cancer centers demonstrated the lowest minimally invasive utilization rate (23.6%; P<.001). After multivariable adjustment, minimally invasive surgery was less likely to be performed in patients with Medicaid compared with private insurance (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.62-0.72), black and Hispanic compared with white patients (adjusted OR 0.43, 95% CI 0.41-0.46 for black and 0.77, 95% CI 0.72-0.82 for white patients), and more likely to be performed in high- compared with low-volume hospitals (adjusted OR 4.22, 95% CI 2.15-8.27). Open hysterectomy was associated with a higher risk of surgical site infection (adjusted OR 6.21, 95% CI 5.11-7.54) and venous thromboembolism (adjusted OR 3.65, 95% CI 3.12-4.27). Surgical cases with complications had higher mean hospitalization costs for all hysterectomy procedure types (P<.001).
Hospital utilization of minimally invasive surgery for the treatment of endometrial cancer varies considerably in the United States, representing a disparity in the quality and cost of surgical care delivered nationwide.</description><subject>African Americans - statistics & numerical data</subject><subject>Aged</subject><subject>Endometrial Neoplasms - surgery</subject><subject>European Continental Ancestry Group - statistics & numerical data</subject><subject>Female</subject><subject>Hispanic Americans - statistics & numerical data</subject><subject>Hospitalization - economics</subject><subject>Hospitals, High-Volume - standards</subject><subject>Hospitals, High-Volume - statistics & numerical data</subject><subject>Hospitals, Low-Volume - standards</subject><subject>Hospitals, Low-Volume - statistics & numerical data</subject><subject>Humans</subject><subject>Hysterectomy - economics</subject><subject>Hysterectomy - methods</subject><subject>Hysterectomy - standards</subject><subject>Medicaid - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures - economics</subject><subject>Minimally Invasive Surgical Procedures - statistics & numerical data</subject><subject>Minimally Invasive Surgical Procedures - trends</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures - economics</subject><subject>Robotic Surgical Procedures - statistics & numerical data</subject><subject>Robotic Surgical Procedures - trends</subject><subject>Surgical Wound Infection - etiology</subject><subject>United States</subject><subject>Venous Thromboembolism - etiology</subject><issn>0029-7844</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUU1PAjEQbYxGEP0HxvToZbFf2-56I4hIgiFGSbxt2qUr1bKL7S4Ef71F8CPOZTIz773JvAHgHKMuRqm46k2GXfQnME7QAWjjRNCIUPp8CNoIkTQSCWMtcOL96xbEU3oMWoRzxjERbaCmtbHmQ9amKmFVwHtTmoW0dgNH5Up6s9LwsXEv2m2gKeGgnFULXTsjLezLMtcuJKevYQ8-NNKaegNlOYP9ytfwxvildKF1Co4Kab0-2-cOmN4Onvp30XgyHPV74yinCLOoUDSlOeE4lZIolQhRKJbwWMUpL1DOCE0VFjHFKJFhyiQSuciTGCsqGcMx7YDLne7SVe-N9nW2MD7X1spSV43PAhlznoo4CVC2g-au8t7pIlu6cLbbZBhlW3ez4G72391Au9hvaNRCz35I33b-6q4rW2vn32yz1i6ba2nr-ZceJzGKSPgDwqGKtsqMfgJsloOC</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Fader, Amanda N.</creator><creator>Weise, R. Matsuno</creator><creator>Sinno, Abdulrahman K.</creator><creator>Tanner, Edward J.</creator><creator>Borah, Bijan J.</creator><creator>Moriarty, James P.</creator><creator>Bristow, Robert E.</creator><creator>Makary, Martin A.</creator><creator>Pronovost, Peter J.</creator><creator>Hutfless, Susan</creator><creator>Dowdy, Sean C.</creator><general>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160101</creationdate><title>Utilization of Minimally Invasive Surgery in Endometrial Cancer Care: A Quality and Cost Disparity</title><author>Fader, Amanda N. ; Weise, R. Matsuno ; Sinno, Abdulrahman K. ; Tanner, Edward J. ; Borah, Bijan J. ; Moriarty, James P. ; Bristow, Robert E. ; Makary, Martin A. ; Pronovost, Peter J. ; Hutfless, Susan ; Dowdy, Sean C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3014-fb393c2619aa2bb877fb4865b596f0c4239b1753108ab874a07c7c851b3a44153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>African Americans - statistics & numerical data</topic><topic>Aged</topic><topic>Endometrial Neoplasms - surgery</topic><topic>European Continental Ancestry Group - statistics & numerical data</topic><topic>Female</topic><topic>Hispanic Americans - statistics & numerical data</topic><topic>Hospitalization - economics</topic><topic>Hospitals, High-Volume - standards</topic><topic>Hospitals, High-Volume - statistics & numerical data</topic><topic>Hospitals, Low-Volume - standards</topic><topic>Hospitals, Low-Volume - statistics & numerical data</topic><topic>Humans</topic><topic>Hysterectomy - economics</topic><topic>Hysterectomy - methods</topic><topic>Hysterectomy - standards</topic><topic>Medicaid - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures - economics</topic><topic>Minimally Invasive Surgical Procedures - statistics & numerical data</topic><topic>Minimally Invasive Surgical Procedures - trends</topic><topic>Retrospective Studies</topic><topic>Robotic Surgical Procedures - economics</topic><topic>Robotic Surgical Procedures - statistics & numerical data</topic><topic>Robotic Surgical Procedures - trends</topic><topic>Surgical Wound Infection - etiology</topic><topic>United States</topic><topic>Venous Thromboembolism - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fader, Amanda N.</creatorcontrib><creatorcontrib>Weise, R. Matsuno</creatorcontrib><creatorcontrib>Sinno, Abdulrahman K.</creatorcontrib><creatorcontrib>Tanner, Edward J.</creatorcontrib><creatorcontrib>Borah, Bijan J.</creatorcontrib><creatorcontrib>Moriarty, James P.</creatorcontrib><creatorcontrib>Bristow, Robert E.</creatorcontrib><creatorcontrib>Makary, Martin A.</creatorcontrib><creatorcontrib>Pronovost, Peter J.</creatorcontrib><creatorcontrib>Hutfless, Susan</creatorcontrib><creatorcontrib>Dowdy, Sean C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fader, Amanda N.</au><au>Weise, R. Matsuno</au><au>Sinno, Abdulrahman K.</au><au>Tanner, Edward J.</au><au>Borah, Bijan J.</au><au>Moriarty, James P.</au><au>Bristow, Robert E.</au><au>Makary, Martin A.</au><au>Pronovost, Peter J.</au><au>Hutfless, Susan</au><au>Dowdy, Sean C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utilization of Minimally Invasive Surgery in Endometrial Cancer Care: A Quality and Cost Disparity</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>127</volume><issue>1</issue><spage>91</spage><epage>100</epage><pages>91-100</pages><issn>0029-7844</issn><eissn>1873-233X</eissn><abstract>To describe case mix-adjusted hospital level utilization of minimally invasive surgery for hysterectomy in the treatment of early-stage endometrial cancer.
In this retrospective cohort study, we analyzed the proportion of patients who had a minimally invasive compared with open hysterectomy for nonmetastatic endometrial cancer using the U.S. Nationwide Inpatient Sample database, 2007-2011. Hospitals were stratified by endometrial cancer case volumes (low=less than 10; medium=11-30; high=greater than 30 cases). Hierarchical logistic regression models were used to evaluate hospital and patient variables associated with minimally invasive utilization, complications, and costs.
Overall, 32,560 patients were identified; 33.6% underwent a minimally invasive hysterectomy with an increase of 22.0-50.8% from 2007 to 2011. Low-volume cancer centers demonstrated the lowest minimally invasive utilization rate (23.6%; P<.001). After multivariable adjustment, minimally invasive surgery was less likely to be performed in patients with Medicaid compared with private insurance (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.62-0.72), black and Hispanic compared with white patients (adjusted OR 0.43, 95% CI 0.41-0.46 for black and 0.77, 95% CI 0.72-0.82 for white patients), and more likely to be performed in high- compared with low-volume hospitals (adjusted OR 4.22, 95% CI 2.15-8.27). Open hysterectomy was associated with a higher risk of surgical site infection (adjusted OR 6.21, 95% CI 5.11-7.54) and venous thromboembolism (adjusted OR 3.65, 95% CI 3.12-4.27). Surgical cases with complications had higher mean hospitalization costs for all hysterectomy procedure types (P<.001).
Hospital utilization of minimally invasive surgery for the treatment of endometrial cancer varies considerably in the United States, representing a disparity in the quality and cost of surgical care delivered nationwide.</abstract><cop>United States</cop><pub>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>26646127</pmid><doi>10.1097/AOG.0000000000001180</doi><tpages>10</tpages></addata></record> |
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| ispartof | Obstetrics and gynecology (New York. 1953), 2016-01, Vol.127 (1), p.91-100 |
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| subjects | African Americans - statistics & numerical data Aged Endometrial Neoplasms - surgery European Continental Ancestry Group - statistics & numerical data Female Hispanic Americans - statistics & numerical data Hospitalization - economics Hospitals, High-Volume - standards Hospitals, High-Volume - statistics & numerical data Hospitals, Low-Volume - standards Hospitals, Low-Volume - statistics & numerical data Humans Hysterectomy - economics Hysterectomy - methods Hysterectomy - standards Medicaid - statistics & numerical data Middle Aged Minimally Invasive Surgical Procedures - economics Minimally Invasive Surgical Procedures - statistics & numerical data Minimally Invasive Surgical Procedures - trends Retrospective Studies Robotic Surgical Procedures - economics Robotic Surgical Procedures - statistics & numerical data Robotic Surgical Procedures - trends Surgical Wound Infection - etiology United States Venous Thromboembolism - etiology |
| title | Utilization of Minimally Invasive Surgery in Endometrial Cancer Care: A Quality and Cost Disparity |
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