title: Uptake and patient outcomes of laparoscopic colon and rectal cancer surgery in a publicly funded system and following financial incentives.
abstract: OBJECTIVE
  To assess patterns of uptake and outcomes of laparoscopic colon and rectal cancer surgery in Ontario, and the potential influence of surgical fee incentives instituted on October 1, 2005.
  
  
  METHODS
  We used Ontario administrative databases from fiscal years 2002 to 2009. Study outcomes were uptake rates of laparoscopic surgery, hospital length of stay, 30-day operative mortality, cancer-specific survival, and overall survival. The main descriptor for multivariable regression models was a 5% increase in rate of laparoscopic colon cancer surgery in the previous year.
  
  
  RESULTS
  The annual rate of laparoscopic colon and rectal cancer surgery, respectively, rose from 8.7 to 38.9% and from 4.8 to 19.6%. The greatest increase in rate of laparoscopic colon surgery occurred shortly after October 1, 2005. For each 5% increase in rate of laparoscopic surgery, the odds of 30-day mortality was 1.0 [95% confidence interval (CI) 0.96-1.01, p = 0.264], the hazard of cancer-specific survival was 1.0 (95% CI 0.97-1.00, p = 0.139), the hazard of overall survival was 1.0 (95% CI 0.98-1.00, p = 0.051), and length of hospital stay was lower (estimate = -0.10, 95% CI -0.14 to -0.06, p < 0.001).
  
  
  CONCLUSIONS
  In Ontario by the year 2009, 39% of colon and 20% of rectal cancer surgery was provided laparoscopically. Increased rates were associated with a minimal decrease in hospital length of stay and no changes in 30-day mortality, cancer-specific survival, or overall survival. Financial incentives were likely responsible for the marked increase in laparoscopic colon cancer surgery observed after October 1, 2005.
authors.affiliation: Department of Surgery, McMaster University, Hamilton, ON, Canada, marko.simunovic@jcc.hhsc.ca.
authors.forename: Marko
authors.initials: M
authors.lastname: Simunovic
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.forename: Margherita
authors.initials: M
authors.lastname: Cadeddu
authors.forename: David
authors.initials: D
authors.lastname: Urbach
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D005380:Financing, Government; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D012052:Reimbursement, Incentive; D015996:Survival Rate