Disparities in Access to Basic Laparoscopic Surgery At US Academic Centers

Background: Laparoscopy is the standard approach for basic gastrointestinal procedures such appendectomy and cholecystectomy. We determined the disparities in access to basic laparoscopic surgeryat U.S. academiccenters.

Methods: A retrospective analysis of a large administrative, clinical, and financial database (University Health System Consortium) of US Academic Medical Centers was conducted.Using appropriate ICD-9-CM procedure codes and diagnosis we identified 112,540 laparoscopic (n=82,062; 72.9%) and open (n=30,478;27.1%) appendectomies and cholecystectomiesover a 4-year period (2005-2009). The odds ratio (OR) for laparoscopic vs. open procedures were calculated and stratified byage (< or ≥ 65 years), gender, race/ethnicity, admission status, severity of illness (surgery risk) and primary payer status.


VariablesOR95% CI
Young vs. old1.331.27-1.39*

Female vs. male


Caucasian vs. Other

Elective vs. emergent1.000.96-1.05
Low vs. high risk1.961.86-2.06*
Private payer vs. Medicare1.251.21-1.29*

95% CI = Confidence interval; *=p<.05 by Chi2

Conclusion:A young, Caucasian female who is low risk andhas private insurance is more likely to receive a laparoscopic approachforthe procedures studied.Disparities in access to basic laparoscopic surgeryexist at U.S. academic centers.

Session: Podium Presentation

Program Number: S015

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