title: Geographic variation in use of laparoscopic colectomy for colon cancer.
abstract: OBJECTIVE
  Emerging evidence supporting the use of laparoscopic colectomy in patients with cancer has led to dramatic increases in utilization. Though certain patient and hospital characteristics may be associated with the use of laparoscopy, the influence of geography is poorly understood.
  
  
  METHODS
  We used national Medicare claims data from 2009 and 2010 to examine geographic variation in utilization of laparoscopic colectomy for patients with colon cancer. Patients were assigned to hospital referral regions (HRRs) where they were treated. Multivariable logistic regression was used to generate age, sex, and race-adjusted rates of laparoscopic colectomy for each HRR. Patient quintiles of adjusted HRR utilization were used to evaluate differences in patient and hospital characteristics across low and high-utilizing HRRs.
  
  
  RESULTS
  A total of 93,786 patients underwent colon resections at 3,476 hospitals during the study period, of which 30,502 (32.5%) were performed laparoscopically. Differences in patient characteristics between the lowest and highest quintiles of HRR utilization were negligible, and there was no difference in the availability of laparoscopic technology. Yet adjusted rates of laparoscopic colectomy utilization varied from 0% to 66.8% across 306 HRRs in the United States.
  
  
  CONCLUSIONS
  There is wide geographic variation in the utilization of laparoscopic colectomy for Medicare patients with colon cancer, suggesting treatment location may substantially influence a patient's options for surgical approach. Future efforts to reduce variation will require increased dissemination of training techniques, novel opportunities for learning among surgeons, and enhanced educational resources for patients.
authors.affiliation: All authors: Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI. breames@umich.edu.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Reames
authors.affiliation: All authors: Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Kyle H
authors.initials: KH
authors.lastname: Sheetz
authors.affiliation: All authors: Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
authors.affiliation: All authors: Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.affiliation: All authors: Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D005843:Geography; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States