title: Disparities in the use of minimally invasive surgery for colorectal disease.
abstract: BACKGROUND
  Morbidity and mortality rates for major surgical procedures are decreased in high-volume hospitals (HVH). Additionally, HVH are often leaders in the utilization of novel surgical technology such as minimally invasive surgery (MIS). Although HVH often serve diverse patient populations, it is unknown if there are disparities in the application of new surgical technologies within these hospitals. We sought to determine if ethnic and socioeconomic disparities in the use of MIS for colorectal disease exist at HVH.
  
  
  METHODS
  Laparoscopic and open colectomies performed at HVH were identified using the 2008 Nationwide Inpatient Sample database. ICD-9 codes were used to identify MIS colorectal resections. Multiple logistic regression including ethnic and socioeconomic variables were used to identify independent predictive factors for undergoing MIS.
  
  
  RESULTS
  A total of 211,862 colorectal resections were performed at HVH in 2008. Only 16,637 (7.3%) colorectal resections were performed using MIS. When evaluating racial and socioeconomic factors, patients within the highest income quartile were more likely to undergo MIS than those in the lowest income groups. In addition, patients with Medicaid and uninsured patients were significantly less likely to undergo MIS compared to patients with private insurance. Lastly, race was not a significant predictive factor for undergoing MIS for colorectal disease at HVH.
  
  
  CONCLUSIONS
  There are significant socioeconomic disparities in the use of MIS for colorectal disease at HVH. Future studies should be aimed at identifying access barriers to MIS in the treatment of colorectal disease.
authors.affiliation: Operative Care Line, The Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. 5A 350, Mailing code OCL 112, Houston, TX 77030, USA. Cr1@bcm.edu
authors.forename: Celia N
authors.initials: CN
authors.lastname: Robinson
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*