title: Neighborhood Variation in the Utilization of Laparoscopy for the Treatment of Colon Cancer.
abstract: BACKGROUND
  The rates of laparoscopic colectomy for colon cancer have steadily increased since its inception. Laparoscopic colectomy currently accounts for a third of colectomy procedures in the United States, but little is known regarding the spatial pattern of the utilization of laparoscopy for colon cancer.
  
  
  OBJECTIVE
  This study evaluated the utilization of laparoscopy for colon cancer at the neighborhood level in Ontario.
  
  
  METHODS
  Retrospective analysis of prospectively collected data was performed.
  
  
  METHODS
  This study was conducted at all hospitals in the province of Ontario.
  
  
  METHODS
  This population-based study included all patients aged ≥18 who received an elective colectomy for colon cancer from April 2008 until March 2012 in the province of Ontario.
  
  
  METHODS
  The primary outcome measure was the neighborhood rates of laparoscopy.
  
  
  RESULTS
  Overall, 9,969 patients underwent surgery, and the cluster analysis identified 74 cold-spot neighborhoods, representing 1.8 million people, or 14% of the population. In the multivariate analysis, patients from rural neighborhoods were less than half as likely to receive laparoscopy, OR 0.44 (95% CI, 0.24-0.84; p = 0.012). Additionally, having a minimally invasive surgery fellowship training facility within the same administrative health region as the neighborhood made it more than 23 times as likely to be a hot spot, OR 25.88 (95% CI, 12.15-55.11; p < 0.001). Neighborhood socioeconomic status was not associated with variation in the utilization of laparoscopy.
  
  
  CONCLUSIONS
  Patient case mix could affect laparoscopy use.
  
  
  CONCLUSIONS
  This study identified an unequal utilization of laparoscopy for colon cancer within Ontario with rural neighborhoods experiencing low rates of laparoscopic colectomy, whereas neighborhoods in the same administrative region as minimally invasive surgery training centers experienced increased utilization. Further study into the causes of this variation in resource allocation is needed to identify ways to improve more efficient spread of knowledge and technical skills advancement.
authors.affiliation: 1 Department of Surgery, McMaster University, Hamilton, Ontario, Canada 2 Division of General Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Aristithes G
authors.initials: AG
authors.lastname: Doumouras
authors.forename: Fady
authors.initials: F
authors.lastname: Saleh
authors.forename: Cagla
authors.initials: C
authors.lastname: Eskicioglu
authors.forename: Nalin
authors.initials: N
authors.lastname: Amin
authors.forename: Margherita
authors.initials: M
authors.lastname: Cadeddu
authors.forename: Dennis
authors.initials: D
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062206:Spatial Analysis; D055815:Young Adult