Minimally invasive colorectal resection more likely for wealthier patients

Digestive Disease Week 2011

CHICAGO — Patients with higher household income and/or private insurance underwent minimally invasive surgery more often compared with poorer patients, according to results presented Sunday at Digestive Disease Week 2011.

"Minimally invasive surgery was significantly underutilized in lower-income groups, patients with Medicaid and uninsured patients," said Celia N. Robinson, MD, a general surgery research fellow at Baylor College of Medicine. "Future studies will be needed to investigate barriers to access to minimally invasive surgery."

Robinson and colleagues used the 2008 National Inpatient Sample database, a retrospective review of laparoscopic colectomies performed at high volume centers, to determine which patients were assigned to minimally invasive surgery. High volume centers were those that performed more than 75 colorectal surgeries per year.

Use of minimally invasive techniques was rare, overall. Physicians performed 98,047 colorectal resections at high volume centers in 2008, but 8.1% of those surgeries were minimally invasive. Of the patients who underwent minimally invasive surgery, 53.1% had private insurance compared with just 2.3% for those with Medicaid (OR=0.86; 95% CI, 0.74-1.0) and 1.5% for uninsured patients.

Patients within the highest income quartile were more likely to undergo minimally invasive surgery than those in the lowest income groups. More than 35.2% of the wealthiest patients, those making $59,000 or more, underwent minimally invasive surgery compared with 16.2% for patients making $1 to $35,000.

Robinson and colleagues did not consider income alongside type of insurance, but Robinson said it was reasonable to assume a correlation between greater income and private insurance.

Patients with colorectal cancer were three times more likely to undergo minimally invasive procedures compared with patients undergoing elective surgery. For patients with malignant neoplasms, 32.4% of patients had minimally invasive surgery (OR=3.21; 95% CI 2.51-4.10) compared with 25.5% (OR=2.26; 95% CI, 1.82-2.80) for those undergoing elective resection.

Robinson said race was not a significant predictive factor for undergoing minimally invasive surgery.

"Race isn't a factor once you control for socioeconomic status,"she said in an interview. "Unfortunately, a lot of ethnic minorities are within the lower income groups and do have government-based insurance more often. But once you control for socioeconomic status, the significance of race is diminished." – by Jason Harris

For more information:

• Robinson C. #305. Presented at: Digestive Disease Week 2011; May 7-10, 2011; Chicago.

Disclosure: Dr. Robinson reports no relevant financial disclosures.

Tanos Bekaii-Saab, MD

I think the results have a reasonable foundation given the large body of data in the medical literature suggesting the presence of disparities. Disparities are very complex to study given the fact that there are many factors in play such as cultural differences. Equal access to healthcare in one study has not been shown to resolve disparities, whereas another suggest the opposite. The medical community is becoming more actively engaged in efforts to understand why treatment differentials occur and how to address them. In this situation, socioeconomic status was the differentiating factor. In others, it is gender, race or ethnic background. The solution lies with establishing policies enhancing diversity in the healthcare workforce and expanding access to specialized care amongst others.

– Tanios Bekaii-Saab, MD
Medical Director of Gastrointestinal Oncology,
The Ohio State Comprehensive Cancer Center, Columbus, Ohio

Follow HemOncToday.com on Twitter.