Disparities in access to basic laparoscopic surgery at U.S. academic medical centers.
BACKGROUND
Laparoscopy is the standard approach used for basic gastrointestinal procedures such appendectomy and cholecystectomy. This study determined the disparities in access to laparoscopic surgery for these commonly performed procedures at U.S. academic medical centers.


METHODS
Using appropriate International Classification of Diseases, 9th ed, Clinical Modification (ICD-9-CM) procedure and diagnosis codes, 112,540 basic gastrointestinal procedures were identified from the University HealthSystem Consortium database over a 4-year period (2005-2009). During this period, 82,062 laparoscopic (72.9%) and 30,478 open (27.1%) procedures were performed. The odds ratios (ORs) for laparoscopic versus open procedures were calculated and stratified for age, gender, race/ethnicity, admission status, severity of illness, and primary payer status.


RESULTS
Univariate analysis showed that young age (OR, 1.33; 95% confidence interval [CI], 1.27-1.39), white race/ethnicity (OR, 1.07; 95% CI, 1.03-1.11), female gender (OR, 1.79; 95% CI, 1.75-1.84), minor severity of illness (OR, 1.49; 95% CI, 1.44-1.53), and commercial/private payer status (OR, 1.25; 95% CI, 1.21-1.29) increased the likelihood that a laparoscopic approach would be used for the procedures studied.


CONCLUSIONS
A disparity in access to basic laparoscopic surgery exists at U.S. academic medical centers based on age, gender, race/ethnicity, severity of illness, and primary payer status.
Varela
J Esteban
JE
Department of Minimally Invasive and Bariatric Surgery, Washington University School of Medicine, 660 South Euclid Avenue Box 8109, St Louis, MO 63110, USA. varelae@wustl.edu
Nguyen
Ninh T
NT
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D044469:Racial Groups; D012306:Risk; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult