Utilization of minimally invasive surgery in endometrial cancer care: A Quality and cost disparity

Amanda N. Fader, R. Matsuno Weise, Abdulrahman K. Sinno, Edward J. Tanner, Bijan J Borah, James P. Moriarty, Robert E. Bristow, Martin A. Makary, Peter J. Pronovost, Susan Hutfless, Sean Christopher Dowdy

Research output: Contribution to journalArticle

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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 (low5less than 10; medium511-30; high5greater 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 highcompared 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.

Original languageEnglish (US)
Pages (from-to)91-100
Number of pages10
JournalObstetrics and Gynecology
Volume127
Issue number1
DOIs
StatePublished - 2016

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Minimally Invasive Surgical Procedures
Quality of Health Care
Endometrial Neoplasms
Hysterectomy
Confidence Intervals
Costs and Cost Analysis
Odds Ratio
Low-Volume Hospitals
Logistic Models
Surgical Wound Infection
Diagnosis-Related Groups
Venous Thromboembolism
Medicaid
Insurance
Hispanic Americans
Inpatients
Hospitalization
Cohort Studies
Retrospective Studies
Databases

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Utilization of minimally invasive surgery in endometrial cancer care : A Quality and cost disparity. / Fader, Amanda N.; Matsuno Weise, R.; Sinno, Abdulrahman K.; Tanner, Edward J.; Borah, Bijan J; Moriarty, James P.; Bristow, Robert E.; Makary, Martin A.; Pronovost, Peter J.; Hutfless, Susan; Dowdy, Sean Christopher.

In: Obstetrics and Gynecology, Vol. 127, No. 1, 2016, p. 91-100.

Research output: Contribution to journalArticle

Fader, AN, Matsuno Weise, R, Sinno, AK, Tanner, EJ, Borah, BJ, Moriarty, JP, Bristow, RE, Makary, MA, Pronovost, PJ, Hutfless, S & Dowdy, SC 2016, 'Utilization of minimally invasive surgery in endometrial cancer care: A Quality and cost disparity', Obstetrics and Gynecology, vol. 127, no. 1, pp. 91-100. https://doi.org/10.1097/AOG.0000000000001180
Fader, Amanda N. ; Matsuno Weise, R. ; Sinno, Abdulrahman K. ; Tanner, Edward J. ; Borah, Bijan J ; Moriarty, James P. ; Bristow, Robert E. ; Makary, Martin A. ; Pronovost, Peter J. ; Hutfless, Susan ; Dowdy, Sean Christopher. / Utilization of minimally invasive surgery in endometrial cancer care : A Quality and cost disparity. In: Obstetrics and Gynecology. 2016 ; Vol. 127, No. 1. pp. 91-100.
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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 (low5less than 10; medium511-30; high5greater 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 highcompared 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.",
author = "Fader, {Amanda N.} and {Matsuno Weise}, R. and Sinno, {Abdulrahman K.} and Tanner, {Edward J.} and Borah, {Bijan J} and Moriarty, {James P.} and Bristow, {Robert E.} and Makary, {Martin A.} and Pronovost, {Peter J.} and Susan Hutfless and Dowdy, {Sean Christopher}",
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T1 - Utilization of minimally invasive surgery in endometrial cancer care

T2 - A Quality and cost disparity

AU - Fader, Amanda N.

AU - Matsuno Weise, R.

AU - Sinno, Abdulrahman K.

AU - Tanner, Edward J.

AU - Borah, Bijan J

AU - Moriarty, James P.

AU - Bristow, Robert E.

AU - Makary, Martin A.

AU - Pronovost, Peter J.

AU - Hutfless, Susan

AU - Dowdy, Sean Christopher

PY - 2016

Y1 - 2016

N2 - 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 (low5less than 10; medium511-30; high5greater 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 highcompared 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.

AB - 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 (low5less than 10; medium511-30; high5greater 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 highcompared 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.

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