Wide variation identified in use of laparoscopy across American hospitals

1. Researchers found significant variation in utilization of minimally invasive surgery in US hospitals. 

2. Urban and not-for-profit hospitals were found to be high users of minimally invasive surgery. 

Evidence Rating Level: 2 (Good)            

Study Rundown: Existing literature has shown that for certain surgeries, minimally invasive surgical techniques can significantly reduce surgical site infections, hospital stays, and improve patient outcomes compared to traditional open surgery techniques. However, despite this evidence, there is little known about adoption rates of minimally invasive surgery in US hospitals. This study investigated the variability in utilization of minimally invasive surgeries for specific procedures (appendectomy, partial colectomy, total abdominal hysterectomy, and lung lobectomy). Researchers found significant variability between hospitals’ observed and predicted proportion of procedures performed using minimally invasive surgery. For example, the mean hospital use of minimally invasive surgery for appendectomy was 71%, with a range of 42% to 93% nationwide, Furthermore, researchers also found that for all surgical procedures measured, urban hospitals and not-for-profit hospitals were more likely to perform minimally invasive surgeries for all procedures compared to rural hospitals and both for-profit and government hospitals (correlations evaluated independently). Based on this analysis, it appears that there are two standards of care in certain surgeries. In many cases, especially rural hospitals, these results could reflect a lack of laparoscopic resources and training available to surgeons who perform a wider range of surgical procedures compared to surgeons in larger urban hospitals.

Click to read the study in BMJ

Relevant Reading: Laparoscopic versus open surgery for suspected appendicitis

In-Depth [retrospective cohort]: Data for this study was gathered during the calendar year of 2010 from 1,051 hospitals in 45 states (hospital numbers vary by procedure due to study protocols). To evaluate the utilization of minimally invasive surgeries, researchers used a logistic regression propensity score model to control for patient demographics and comorbidities that would prohibit a minimally invasive surgery. For appendectomy, the mean hospital utilization of minimally invasive surgery was 71.0%, for colectomy 28.4%, for hysterectomy 13.0%, and for lung lobectomy 32.0%. Researchers then grouped hospitals into low, medium, and high categories based on their actual to predicted proportion of minimally invasive surgeries. Using these categories, researchers were able to evaluate specific characteristics of hospitals. For instance, urban hospitals across all but one category and procedure had greater than 61.1% minimally invasive surgeries. In a similar method, not-for-profit hospitals were found to have greater percentages of minimally invasive surgeries (62.3% was the lowest for hysterectomy) across all categories and procedures when compared to for-profit (17.8% was the highest for colectomy) and government run hospitals (20.6% was the highest for hysterectomy). These findings reflect a significant variability in standards of care for certain procedures across multiple indices.

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