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The study collected data from the National Cancer Database which organizes oncology data from more than 1500 accredited cancer facilities across the United States and Puerto Rico. The main outcome variable was the performance of minimally invasive surgery for the associated cancer type. Secondary outcome variables included surgical margin, conversion to open, length of stay, 30-day unanticipated readmission rate, 30-day mortality, 90-day mortality, and overall survival. The main independent variable was hospital type and facility-level variables included location by US region, center type, and average center volume.
The results of the study found that of 234, 935 cases, 48.5% of colorectal cancer surgeries were performed in comprehensive community hospitals, 28% in academic, 12.5% in community, and 11.1% in integrated networks. Many procedures performed in community hospitals were open, while all other hospital types primarily performed minimally invasive surgery. The percentage of robotic surgeries was highest in academic hospitals (7.9%) and lowest in community centers (3.3%).
The study findings showed rates of MIS utilization overall (40.1%), as well as for laparoscopic (36.8%) and robotic (3.3%) procedures specifically, were lowest in community hospitals compared with comprehensive community (46.2% laparoscopic; 5.7% robotic), integrated network (47.7% laparoscopic; 6.8% robotic), and academic (46.3% laparoscopic; 7.9% robotic) centers.
MIS utilization rates varied substantially by hospital type for both the laparoscopic and robotic approaches however were generally lower at community centers for both cancer types. Also, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors with higher 30-day and 90-day mortality. In conclusion, “Future research and healthcare policy must address these trends at the community level to facilitate safe, effective access to these techniques across the US.”
This research was supported by a grant from the Georgetown Howard Universities Center for Clinical and Translational Science and The Lee Folger Foundation.
The research team included researchers from the MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute, and MedStar-Georgetown University Hospital: Anthony M. Villano MD, Alexander Zeymo MS, Brenna K. Houlihan MD, Mohammed Bayasi MD, Waddah B. Al-Refaie MD, FACS and Kitty S. Chan PhD.
Journal of Surgical Research, 2020. DOI: 10.1093/jbcr/irz168