Utilization of Minimally Invasive Surgery in Endometrial Cancer Care

A Quality and Cost Disparity

Abstract

OBJECTIVE: 

To describe case mix-adjusted hospital level utilization of minimally invasive surgery for hysterectomy in the treatment of early-stage endometrial cancer.

METHODS: 

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.

RESULTS: 

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).

CONCLUSION: 

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.

In Brief

Hospital utilization of minimally invasive surgery in endometrial cancer treatment varies considerably, representing a disparity in the quality and cost of surgical care delivered nationwide.