The centralization of robotic surgery in high-volume centers for endometrial cancer patients--a study of 6560 cases in the U.S.
OBJECTIVE
To evaluate the hospital and patient factors associated with robotic surgery for endometrial cancer in the United States.


METHODS
Data was obtained from the Nationwide Inpatient Sample from the year 2010. Chi-squared and multivariate analyses were used for statistical analysis.


RESULTS
Of the 6560 endometrial cancer patients who underwent surgery, the median age was 62 (range: 22 to 99). 1647 (25%) underwent robotic surgery, 820 (13%) laparoscopic, and 4093 (62%) had open surgery. The majority was White (65%). Hospitals with 76 or more hysterectomy cases for endometrial cancer patients per year (4% of hospitals in the study) performed 31% of all hysterectomies and 40% of all robotic hysterectomies (p<0.01). 29% of Whites had robotic surgery compared to 15% of Hispanics, 12% of Blacks, and 11% of Asians (p<0.01). Patients with upper-middle and high incomes underwent robotic surgery more than patients with low or middle incomes (p<0.01). 27% of Medicare patients and 26% of patients with private insurance had robotic surgery compared to only 14% of Medicaid patients and 12% of uninsured patients (p<0.01).


CONCLUSIONS
The majority of robotic surgeries for endometrial cancer were performed at a small number of high-volume hospitals in the United States. Socioeconomic status, insurance type, and race were also important predictors for the use of RS. Further studies are warranted to better understand the barriers to receiving minimally invasive surgery.
Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, USA. Electronic address: chanjohn@sutterhealth.org.
John K
JK
Chan
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
Austin B
AB
Gardner
Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, USA.
Katie
K
Taylor
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Kevin
K
Blansit
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
Caroline A
CA
Thompson
Division of Gynecologic Oncology, University Of California, San Francisco, San Francisco, CA, USA.
Rebecca
R
Brooks
Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, USA.
Xinhua
X
Yu
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
Daniel S
DS
Kapp
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D016889:Endometrial Neoplasms / Q000191:economics / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
Centralization; Endometrial cancer; High-volume hospitals; Laparoscopic surgery; Race and socioeconomic factors; Robotic surgery