Disparities in Utilization and Outcomes of Minimally Invasive Techniques for Gastric Cancer Surgery in the United States

Abstract

Background This study investigated national implementation patterns and perioperative outcomes of minimally invasive gastrectomy (MIG) in gastric cancer surgery in the United States. Methods The National Inpatient Sample (NIS) was queried for patients who underwent elective gastrectomy for gastric cancer from 2008-2018. The MIG versus open gastrectomy approach was correlated with hospital factors, patient characteristics, and complications. Results There was more than a fivefold increase in MIG from 5.8% in 2008 to 32.9% in 2018 (nptrend < 0.001). Patients undergoing MIG had a lower Elixhauser Comorbidity Index (p = 0.001). On risk adjusted analysis, black patients (AOR = 0.77, p = 0.024) and patients with income below 25th percentile (AOR = 0.80, p = 0.018) were less likely to undergo MIG. When these analyses were limited to minimally invasive capable centers only, these differences were not observed. Hospitals in the upper tertile of gastrectomy case volume, Northeast, and urban teaching centers were more likely to perform MIG. Overall, MIG was associated with a 0.7-day decrease in length of stay, reduced risk adjusted mortality rates (AOR = 0.58, p = 0.05), and a $4,700 increase in total cost. Conclusions In this national retrospective study, we observe socioeconomic differences in patients undergoing MIG, which is explained by hospital level factors in MIG utilization. We demonstrate that MIG is associated with a lower mortality compared with open gastrectomy. Establishing MIG as a safe approach to gastric cancers and understanding regional differences in implementation patterns can inform delivery of equitable high-quality health care.

National outcomes of expedited discharge following esophagectomy for malignancy

“…Patient risk profile as well as institutional practice patterns are known to influence morbidity following surgery as well as expected postoperative length of stay [29,30]. In our analysis, we found several operative and hospital factors to be associated with increased odds of expedited discharge.…”

Laparoscopic compared to open approach for distal gastrectomy may reduce pneumonia risk for patients with gastric cancer

“…1). While the NSQIP database does not differentiate between hospital demographics, previous studies have shown socioeconomic differences in the utilization of LG could be explained by hospital level factors [ 48 ].…”

Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

“…Perioperative costs are partially attributable to operative times and surgical equipment, leading to a higher cost attributed to minimally invasive approaches. A national database review from Park et al 53 reported a $4700 higher hospital cost for MIG compared with OG, whereas other studies have indicated that cost increases are more likely associated with RG compared with LG. For example, Lu et al 54 documented total hospital costs of $13,423 for RG compared with $10,165 for LG ( p < .001); but Jin et al 56 calculated a mean difference of $19,141 in perioperative costs between RG and LG.…”

“…51,52 Results are similarly mixed for postoperative mortality; however, overall, RG appears to be noninferior to OG. 49,50 Authors of national database analyses concluded that MIG was associated with improved rates of 30-day 53 and 90-day mortality, 44 but the proportion of MIG cases that were performed robotically is unclear.…”