title: Growth of laparoscopic colectomy in the United States: analysis of regional and socioeconomic factors over time.
abstract: OBJECTIVE
  The study was designed to determine the growth pattern and current rate of laparoscopic partial colectomy in the United States and analyze various factors that influence the adaptation rate over time.
  
  
  BACKGROUND
  Laparoscopic colectomy has been shown to have significant short- and long-term benefits compared with the open approach. Despite the evidence from multiple, prospective, randomized trials, the adoption rate in the Unites States is reported to be low.
  
  
  METHODS
  The Nationwide Inpatient Database was used to estimate the rate of laparoscopic partial colectomy in the United States for the years 1996, 2000, 2004, 2008, and 2009 and examine the growth pattern. Multivariate logistic regression analysis was used to determine the impact of the following patient and hospital variables: age, sex, race, payer status, hospital region, and hospital location and teaching status. Significant factors were analyzed for changes over time.
  
  
  RESULTS
  Overall, 226,585 partial colectomies were identified. The rate of laparoscopic colectomy was 2.2% (878/38,264) for 1996, 2.7% (1175/42,166) for 2000, 5% (2336/44,817) for 2004, 15% (7548/42,903) for 2008, and 31.4% (14,610/31,888) for 2009. A noticeable change of the growth rate of laparoscopic partial colectomies was noted after 2004, with a significant increase and a possible tipping point after 2008.Urban hospital location [odds ratio (OR = 1.71)], teaching hospital status (OR = 1.21), and private insurance status (OR = 1.46) are significant hospital characteristics predicting the use of laparoscopy overall, but teaching hospital status is not significant after 2008 (OR = 1.51 in 1996 to OR = 1.09 in 2008). Age above 80 years significantly decreases the utilization of laparoscopy (OR = 0.78 for age 80-89 years and 0.69 for >90 years). African American race (OR = 0.84), Medicaid insurance status (OR = 0.52), and self-pay (0.6) are significant socioeconomic characteristics negatively influencing the use of the minimal invasive technique.
  
  
  CONCLUSIONS
  A marked increase in the rate of laparoscopic colectomy is seen in recent years. The minimal invasive technique seems to be increasingly used in nonteaching hospitals. Significant socioeconomic differences in access to minimal invasive techniques persist.
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, University of Nevada, School of Medicine, Las Vegas, NV 89103, USA. Ovunc.Bardakcioglu@mac.com
authors.forename: Ovunc
authors.initials: O
authors.lastname: Bardakcioglu
authors.forename: Ashraf
authors.initials: A
authors.lastname: Khan
authors.forename: Christopher
authors.initials: C
authors.lastname: Aldridge
authors.forename: Jiajing
authors.initials: J
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult