Variation in the Utilization of Minimally Invasive Surgical Operations

Autor: Lindsay E. Kuo, Kenric M. Murayama, Rachel R. Kelz, Kristina D. Simmons
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
endocrine system diseases
Databases
Factual
medicine.medical_treatment
Patient demographics
Bariatric Surgery
Fundoplication
030230 surgery
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Sex Factors
Outcome Assessment
Health Care
otorhinolaryngologic diseases
medicine
Appendectomy
Humans
Minimally Invasive Surgical Procedures
Cholecystectomy
GeneralLiterature_REFERENCE(e.g.
dictionaries
encyclopedias
glossaries)
Colectomy
Digestive System Surgical Procedures
Retrospective Studies
ComputingMilieux_THECOMPUTINGPROFESSION
business.industry
General surgery
Incidence
Patient Selection
Background data
Age Factors
Population demographics
United States
Variation (linguistics)
Treatment Outcome
030220 oncology & carcinogenesis
Surgery
Female
Laparoscopy
Hospital service
business
Zdroj: Annals of surgery. 265(3)
ISSN: 1528-1140
Popis: 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.
Databáze: OpenAIRE
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