Monirah Al Nasser, MD, Eric Schneider, PhD, Susan Gearhart, MD, Elizabeth Wick, MD, Sandy Fang, MD, Adil Haider, MD, MPH, Jonathan Efron, MD
Johns Hopkins University
INTRODUCTION: Racial disparity in the treatment of colorectal cancer has been cited as a potential cause for differences in mortality. This study compares the rates of laparoscopic procedures performed for colon cancer with respect to race, insurance status, geographic location, and hospital size.
METHODS: The Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) database was queried to identify patients with the diagnosis of colorectal cancer (CRC) by the International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariate logistic regression was performed to look at age, gender, insurance coverage, academic vs. non-academic affiliated institutions, rural vs. urban settings, location, and proportional differences in laparoscopic procedures according to race.
RESULTS: 14,502 patients were identified. 4,691 (32.35%) underwent laparoscopic colorectal procedures and 9,811 (67.65%) underwent open procedures. The proportion of laparoscopic procedures did not differ significantly by race: Caucasian 32.4%, African-American 30.04%, Hispanic 33.99%, and Asian-Pacific Islander 35.12%. (p≤0.080). Among Caucasian and African-American patients, those covered by private insurers were more likely to undergo laparoscopic procedures compared to those covered by Medicare, Medicaid, and the uninsured; whereas, within the Hispanic patients those with Medicare were more likely to have a laparoscopic procedure.(see table) The Odd of receiving a laparoscopic procedure at teaching hospitals was 1.37 times greater than in non-teaching hospitals, 95%CI [1.27-1.47] and did not differ across race groups. Patients treated at urban hospitals demonstrated higher odds of laparoscopic surgery, 2.25, 95%CI [1.97-2.57] than patients in rural hospitals; this relationship was consistent within races. The odds of undergoing laparoscopic surgeries was lowest in the Midwest region (0.87, 95%CI [0.80-0.96]) but higher in the Southern region (1.15, 95%CI [1.07-1.24]) compared to the Eastern and Western regions.
CONCLUSION: Nearly one third of all colon cancer operations are laparoscopically performed. Race does not appear to play a significant role in the selection of the laparoscopic approach for colon cancer. However, there are significant differences in the selection of laparoscopy for colon cancer patients based on insurance status, geographic location, and hospital type.
Rates of Laparoscopic Colonic Resections Comparing Race and Insurance Type
| Medicare | Medicaid | Private | Uninsured | p | |
| Caucasian | 30.81% | 24.92% | 37.40% | 20.47% | <0.001 |
| African Americans | 28.85% | 17.47% | 36.92% | 20.22% | <0.001 |
| Hispanic | 38.49% | 20.49% | 37.42% | 16.67% | <0.001 |
Session: Podium Presentation
Program Number: S072