Geographic variation in use of laparoscopic colectomy for colon cancer

Bradley N. Reames, Kyle H. Sheetz, Seth A. Waits, Justin B. Dimick, Scott E. Regenbogen

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose Emerging evidence supporting the use of laparoscopic colectomy in patients with cancer has led to dramatic increases in utilization. Though certain patient and hospital characteristics may be associated with the use of laparoscopy, the influence of geography is poorly understood.

Methods We used national Medicare claims data from 2009 and 2010 to examine geographic variation in utilization of laparoscopic colectomy for patients with colon cancer. Patients were assigned to hospital referral regions (HRRs) where they were treated. Multivariable logistic regression was used to generate age, sex, and race-adjusted rates of laparoscopic colectomy for each HRR. Patient quintiles of adjusted HRR utilization were used to evaluate differences in patient and hospital characteristics across low and high-utilizing HRRs.

Results A total of 93,786 patients underwent colon resections at 3,476 hospitals during the study period, of which 30,502 (32.5%) were performed laparoscopically. Differences in patient characteristics between the lowest and highest quintiles of HRR utilization were negligible, and there was no difference in the availability of laparoscopic technology. Yet adjusted rates of laparoscopic colectomy utilization varied from 0% to 66.8% across 306 HRRs in the United States.

Conclusion There is wide geographic variation in the utilization of laparoscopic colectomy for Medicare patients with colon cancer, suggesting treatment location may substantially influence a patient's options for surgical approach. Future efforts to reduce variation will require increased dissemination of training techniques, novel opportunities for learning among surgeons, and enhanced educational resources for patients.

Original languageEnglish (US)
Pages (from-to)3667-3672
Number of pages6
JournalJournal of Clinical Oncology
Volume32
Issue number32
DOIs
StatePublished - Nov 10 2014

Fingerprint

Colectomy
Colonic Neoplasms
Referral and Consultation
Medicare
Geography
Laparoscopy
Teaching
Colon
Logistic Models
Learning
Technology

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Geographic variation in use of laparoscopic colectomy for colon cancer. / Reames, Bradley N.; Sheetz, Kyle H.; Waits, Seth A.; Dimick, Justin B.; Regenbogen, Scott E.

In: Journal of Clinical Oncology, Vol. 32, No. 32, 10.11.2014, p. 3667-3672.

Research output: Contribution to journalArticle

Reames, Bradley N. ; Sheetz, Kyle H. ; Waits, Seth A. ; Dimick, Justin B. ; Regenbogen, Scott E. / Geographic variation in use of laparoscopic colectomy for colon cancer. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 32. pp. 3667-3672.
@article{bb8710d34a9642a5ad042933f2dd9868,
title = "Geographic variation in use of laparoscopic colectomy for colon cancer",
abstract = "Purpose Emerging evidence supporting the use of laparoscopic colectomy in patients with cancer has led to dramatic increases in utilization. Though certain patient and hospital characteristics may be associated with the use of laparoscopy, the influence of geography is poorly understood.Methods We used national Medicare claims data from 2009 and 2010 to examine geographic variation in utilization of laparoscopic colectomy for patients with colon cancer. Patients were assigned to hospital referral regions (HRRs) where they were treated. Multivariable logistic regression was used to generate age, sex, and race-adjusted rates of laparoscopic colectomy for each HRR. Patient quintiles of adjusted HRR utilization were used to evaluate differences in patient and hospital characteristics across low and high-utilizing HRRs.Results A total of 93,786 patients underwent colon resections at 3,476 hospitals during the study period, of which 30,502 (32.5{\%}) were performed laparoscopically. Differences in patient characteristics between the lowest and highest quintiles of HRR utilization were negligible, and there was no difference in the availability of laparoscopic technology. Yet adjusted rates of laparoscopic colectomy utilization varied from 0{\%} to 66.8{\%} across 306 HRRs in the United States.Conclusion There is wide geographic variation in the utilization of laparoscopic colectomy for Medicare patients with colon cancer, suggesting treatment location may substantially influence a patient's options for surgical approach. Future efforts to reduce variation will require increased dissemination of training techniques, novel opportunities for learning among surgeons, and enhanced educational resources for patients.",
author = "Reames, {Bradley N.} and Sheetz, {Kyle H.} and Waits, {Seth A.} and Dimick, {Justin B.} and Regenbogen, {Scott E.}",
year = "2014",
month = "11",
day = "10",
doi = "10.1200/JCO.2014.57.1588",
language = "English (US)",
volume = "32",
pages = "3667--3672",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "32",

}

TY - JOUR

T1 - Geographic variation in use of laparoscopic colectomy for colon cancer

AU - Reames, Bradley N.

AU - Sheetz, Kyle H.

AU - Waits, Seth A.

AU - Dimick, Justin B.

AU - Regenbogen, Scott E.

PY - 2014/11/10

Y1 - 2014/11/10

N2 - Purpose Emerging evidence supporting the use of laparoscopic colectomy in patients with cancer has led to dramatic increases in utilization. Though certain patient and hospital characteristics may be associated with the use of laparoscopy, the influence of geography is poorly understood.Methods We used national Medicare claims data from 2009 and 2010 to examine geographic variation in utilization of laparoscopic colectomy for patients with colon cancer. Patients were assigned to hospital referral regions (HRRs) where they were treated. Multivariable logistic regression was used to generate age, sex, and race-adjusted rates of laparoscopic colectomy for each HRR. Patient quintiles of adjusted HRR utilization were used to evaluate differences in patient and hospital characteristics across low and high-utilizing HRRs.Results A total of 93,786 patients underwent colon resections at 3,476 hospitals during the study period, of which 30,502 (32.5%) were performed laparoscopically. Differences in patient characteristics between the lowest and highest quintiles of HRR utilization were negligible, and there was no difference in the availability of laparoscopic technology. Yet adjusted rates of laparoscopic colectomy utilization varied from 0% to 66.8% across 306 HRRs in the United States.Conclusion There is wide geographic variation in the utilization of laparoscopic colectomy for Medicare patients with colon cancer, suggesting treatment location may substantially influence a patient's options for surgical approach. Future efforts to reduce variation will require increased dissemination of training techniques, novel opportunities for learning among surgeons, and enhanced educational resources for patients.

AB - Purpose Emerging evidence supporting the use of laparoscopic colectomy in patients with cancer has led to dramatic increases in utilization. Though certain patient and hospital characteristics may be associated with the use of laparoscopy, the influence of geography is poorly understood.Methods We used national Medicare claims data from 2009 and 2010 to examine geographic variation in utilization of laparoscopic colectomy for patients with colon cancer. Patients were assigned to hospital referral regions (HRRs) where they were treated. Multivariable logistic regression was used to generate age, sex, and race-adjusted rates of laparoscopic colectomy for each HRR. Patient quintiles of adjusted HRR utilization were used to evaluate differences in patient and hospital characteristics across low and high-utilizing HRRs.Results A total of 93,786 patients underwent colon resections at 3,476 hospitals during the study period, of which 30,502 (32.5%) were performed laparoscopically. Differences in patient characteristics between the lowest and highest quintiles of HRR utilization were negligible, and there was no difference in the availability of laparoscopic technology. Yet adjusted rates of laparoscopic colectomy utilization varied from 0% to 66.8% across 306 HRRs in the United States.Conclusion There is wide geographic variation in the utilization of laparoscopic colectomy for Medicare patients with colon cancer, suggesting treatment location may substantially influence a patient's options for surgical approach. Future efforts to reduce variation will require increased dissemination of training techniques, novel opportunities for learning among surgeons, and enhanced educational resources for patients.

UR - http://www.scopus.com/inward/record.url?scp=84911864302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911864302&partnerID=8YFLogxK

U2 - 10.1200/JCO.2014.57.1588

DO - 10.1200/JCO.2014.57.1588

M3 - Article

C2 - 25287826

AN - SCOPUS:84911864302

VL - 32

SP - 3667

EP - 3672

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 32

ER -