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Variation in the Utilization of Minimally Invasive Surgical Operations
Lindsay E Kuo1, Kenric Murayama, Kristina D Simmons
1*Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA †Department of Surgery, University of Hawaii, Honolulu, HI.
Objective:
The goal of this study was to examine regional variation in use of minimally invasive surgical (MIS) operations.
Summary Background Data:
Regional variation exists in performance of surgical operations. Variation in the use of MIS has not been studied.
Methods:
Five operations that are performed open or MIS were selected: cholecystectomy, appendectomy, colectomy, antireflux, and bariatric. A 3-state database from 2008 to 2011 was used; states were divided into hospital service areas (HSAs). For each operation, the percentage of MIS operations was calculated. HSAs with less than 50% or more than 150% of the MIS average were considered outliers. Population demographics, geography, and hospital and physician presence were compared between HSAs. Rates of performance by patient disease and the presence of MIS surgeons were also investigated.
Results:
MIS cholecystectomy was performed with low variation; MIS appendectomy, antireflux, and bariatric operations with medium variation; and MIS colectomy with high variation. With the exception of MIS colectomy, there were no differences in the patient demographics, geography, or disease types treated with an MIS approach between HSAs with low-, non-, or high utilization of MIS. There is no correlation between the number of MIS surgeons and the percentage of procedures performed MIS.
Conclusions:
Variation in utilization of MIS exists and differs by operation. Patient demographics, patient disease, and the ability to access care are associated only with variation in use of MIS for colectomy. For all other operations studied, these factors do not explain variation in MIS use. Further investigation is warranted to identify and eliminate causes of variation.
Insights
Minimally invasive surgery (MIS) use varies by operation, with colectomy showing high variation. Patient factors and access to care only explain colectomy variation, not other MIS procedures.
Area of Science:
- Surgical innovation and healthcare delivery
- Health services research
Background:
- Regional variations in surgical procedure performance are documented.
- However, the specific variation in minimally invasive surgery (MIS) utilization across different geographic areas remains understudied.
Purpose of the Study:
- To investigate and quantify regional disparities in the adoption and use of minimally invasive surgical (MIS) procedures.
- To identify factors contributing to the variation in MIS utilization across different surgical operations.
Main Methods:
- Analysis of a 3-state database (2008-2011) encompassing five key operations (cholecystectomy, appendectomy, colectomy, antireflux, bariatric) performed via open or MIS approaches.
- Hospital Service Areas (HSAs) were used to calculate MIS percentages, identifying outliers. Comparisons included patient demographics, geography, disease prevalence, and surgeon availability.
Main Results:
- Minimally invasive surgery (MIS) utilization demonstrated low variation for cholecystectomy, medium for appendectomy, antireflux, and bariatric procedures, and high variation for colectomy.
- Except for colectomy, no significant differences in patient demographics, geography, or disease characteristics were found between high and low MIS utilization areas.
- The number of surgeons trained in MIS did not correlate with the percentage of MIS procedures performed.
Conclusions:
- Significant regional variation exists in the utilization of minimally invasive surgery (MIS), varying by surgical procedure.
- Factors such as patient demographics, disease type, and healthcare access only explain variation in MIS colectomy rates.
- Further research is essential to uncover the underlying causes of MIS utilization disparities for other common surgical procedures to ensure equitable access and optimal patient care.
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