Utilization of Minimally Invasive Surgery in Endometrial Cancer Care: A Quality and Cost Disparity : Obstetrics & Gynecology

Secondary Logo

Journal Logo

Contents: Gynecologic Oncology: Original Research

Utilization of Minimally Invasive Surgery in Endometrial Cancer Care

A Quality and Cost Disparity

Fader, Amanda N. MD; Weise, R. Matsuno PhD; Sinno, Abdulrahman K. MD; Tanner, Edward J. III MD; Borah, Bijan J. PhD; Moriarty, James P. MS; Bristow, Robert E. MD, MBA; Makary, Martin A. MD, MPH; Pronovost, Peter J. MD, PhD; Hutfless, Susan PhD; Dowdy, Sean C. MD

Author Information
Obstetrics & Gynecology 127(1):p 91-100, January 2016. | DOI: 10.1097/AOG.0000000000001180


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.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Full Text Access for Subscribers:

You can read the full text of this article if you:

Access through Ovid