Wide Geographic Variation in Use of Laparoscopic Colectomy for Colon Cancer


Key Points

  • Use of laparoscopic resection by hospital referral region ranged from 0% to 66.8%.
  • Highest and lowest use rates were often found in adjacent hospital referral regions. 

There has been a dramatic increase in the use of laparoscopic colectomy for colon cancer. In a Medicare data study reported in the Journal of Clinical Oncology, Reames and colleagues found that use of laparoscopic colectomy varied from 0% to 66.8% across hospital referral regions in the United States.

The study involved national Medicare claims data from 2009 and 2010 for 93,786 patients undergoing colon resection at 3,476 hospitals. Patients were assigned to 1 of 366 hospital referral regions for geographic analysis. Patients had a median age of 77 years, 54% were female, 10% were African American, and 63% had right colectomy and 30% had left colectomy. A total of 30,502 resections (32.5%) were performed laparoscopically.

Factors Associated With Greater Use

Most hospitals in the study had fewer than 200 beds and were not for profit, located in urban areas, and nonteaching hospitals. Hospital referral region quintiles of laparoscopic colectomy use adjusted for age, sex, and race were 0% to 23.7% (98 hospital referral regions), 23.8% to 30.6% (65 hospital referral regions), 30.7% to 35.7% (46 hospital referral regions), 35.8% to 40.3% (36 hospital referral regions), and 40.5% to 66.8% (61 hospital referral regions).

Greater than 98.6% of hospitals in each quintile had access to laparoscopic equipment. Hospitals in the highest- vs lowest-quintile hospital referral regions had higher annual colectomy volume (29 vs 23, P < .01), were more likely to be designated cancer centers (42.1% vs 34.3%, P < .01) and teaching hospitals (22.3% vs17.8%, P < .01), had more than 200 beds (33.5% vs 24.5%, P < .01), and had high hospital technology (32.0% vs 25.3%, P < .01). Low-utilization hospitals were more likely to be critical-access hospitals (22.6% vs 7.7% in the highest quintile, P < .01).

Geographic Variation

By hospital referral region, adjusted use of laparoscopic colectomy varied from 0% (Yakima, Washington) to 66.8% (San Luis Obispo, California). Use was high in parts of New York and in Arizona, Utah, New Mexico, and Colorado, and low in west Texas, Appalachia (West Virginia and western Virginia) and northern border states (Montana and North Dakota). However, in multiples locales including the mountain region (near Wyoming and Colorado) and the mid-Atlantic region (New York and Pennsylvania), the lowest and highest rates of laparoscopic colectomy use were observed in adjacent hospital referral regions.

The investigators concluded: “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.”

The study was supported by the National Cancer Institute.

Bradley N. Reames, MD, MS, Center for Healthcare Outcomes & Policy, University of Michigan, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.