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Hospital Minimally Invasive Surgery Utilization for Gastrointestinal Cancer

Mason, Meredith C., MD*,†; Tran Cao, Hop S., MD; Awad, Samir S., MD, MPH*,†; Farjah, Farhood, MD, MPH; Chang, George J., MD, MS§; Massarweh, Nader N., MD, MPH*,†

doi: 10.1097/SLA.0000000000002302
Original Articles

Objective: The aim of the study was to evaluate the impact of receiving care at high minimally invasive surgery (MIS)-utilizing hospitals

Background: MIS techniques are used across surgical specialties. The extent of MIS utilization for gastrointestinal (GI) cancer resection and impact of receiving care at high utilizing hospitals is unclear.

Methods: This is a retrospective cohort study of 137,581 surgically resected esophageal, gastric, pancreatic, hepatobiliary, colon, and rectal cancer patients within the National Cancer Data Base (2010–2013). Disease-specific, hospital-level, reliability-adjusted MIS utilization rates were calculated to evaluate perioperative outcomes. Among patients for whom adjuvant chemotherapy (AC) was indicated, the association between days to AC and hospital MIS utilization was examined using generalized estimating equations. Association with risk of death was evaluated using multivariable Cox regression.

Results: Disease-specific MIS use increased significantly [42.0%–68.3% increase; trend test, P < 0.001 for all except hepatobiliary (P = 0.007)] over time. Most hospitals [range—30.3% (colon); 92.9% (pancreatic)] were low utilizers (≤30% of cases). Higher MIS utilization is associated with increased lymph nodes examined (P < 0.001, all) and shorter length of stay (P < 0.001, all). Each 10% increase in MIS utilization is associated with fewer days to AC [3.3 (95% confidence interval, 1.2–5.3) for MIS gastric; 3.3 ([0.7–5.8) for open gastric; 1.1 (0.3–2.0) days for open colon]. An association between MIS utilization and risk of death was observed for colon [Q2—hazard ratio (HR) 0.96 (0.89–1.02); Q3—HR 0.91 (0.86–0.98); Q4—HR 0.87 (0.82–0.93)] and rectal cancer [Q2—HR 0.89 (0.76–1.05); Q3—HR 0.84 (0.82–0.97); Q4—HR 0.86 (0.74–0.98)].

Conclusions: Most hospitals treating GI malignancies are low MIS utilizers. Our findings may reflect real-world MIS effectiveness for oncologic resection and could be useful for identifying hospitals with infrastructure and/or processes beneficial for multimodality cancer care.

*Houston VA Center for Innovations In Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX

Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX

Department of Surgery and Surgical Outcomes Research Center, University of Washington, Seattle, WA

§Department of Surgical Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.

Reprints: Nader N. Massarweh, MD, MPH, Assistant Professor of Surgery, Michael E DeBakey VA Medical Center 2002 Holcombe Blvd (OCL 112), Houston, TX 77030. E-mail: massarwe@bcm.edu.

This work was funded by an award from the Cancer Prevention and Research Institute of Texas and supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).

Previous Presentation: This work was orally presented at the Association for Academic Surgery/Society of University Surgeons Academic Surgical Congress 2017.

Role of the Sponsor: The funding body played no part in the design and/or general conduct of this study, had no access to the data or role in data collection, management, analysis, or interpretation, and had no role in preparation, review, or approval of the manuscript.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, Baylor College of Medicine, or the Cancer Prevention and Research Institute of Texas. The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data.

The authors report no conflicts of interest.

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