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Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer.

Publication ,  Journal Article
Turner, M; Adam, MA; Sun, Z; Kim, J; Ezekian, B; Yerokun, B; Mantyh, C; Migaly, J
Published in: Ann Surg
April 2017

OBJECTIVE: To determine the impact of race and insurance on use of minimally invasive (MIS) compared with open techniques for rectal cancer in the United States. BACKGROUND: Race and socioeconomic status have been implicated in disparities of rectal cancer treatment. METHODS: Adults undergoing MIS (laparoscopic or robotic) or open rectal resections for stage I to III rectal adenocarcinoma were included from the National Cancer Database (2010-2012). Multivariate analyses were employed to examine the adjusted association of race and insurance with use of MIS versus open surgery. RESULTS: Among 23,274 patients, 39% underwent MIS and 61% open surgery. Overall, 86% were white, 8% black, and 3% Asian. Factors associated with use of open versus MIS were black race, Medicare/Medicaid insurance, and lack of insurance. However, after adjustment for patient demographic, clinical, and treatment characteristics, black race was not associated with use of MIS versus open surgery [odds ratio [OR] 0.90, P = 0.07). Compared with privately insured patients, uninsured patients (OR 0.52, P < 0.01) and those with Medicare/Medicaid (OR 0.79, P < 0.01) were less likely to receive minimally invasive resections. Lack of insurance was significantly associated with less use of MIS in black (OR 0.59, P = 0.02) or white patients (OR 0.51, P < 0.01). However, among uninsured patients, black race was not associated with lower use of MIS (OR 0.96, P = 0.59). CONCLUSIONS: Insurance status, not race, is associated with utilization of minimally invasive techniques for oncologic rectal resections. Due to the short-term benefits and cost-effectiveness of minimally invasive techniques, hospitals may need to improve access to these techniques, especially for uninsured patients.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

April 2017

Volume

265

Issue

4

Start / End Page

774 / 781

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Rectal Neoplasms
  • Racial Groups
  • Proctoscopy
  • Multivariate Analysis
 

Citation

APA
Chicago
ICMJE
MLA
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Turner, M., Adam, M. A., Sun, Z., Kim, J., Ezekian, B., Yerokun, B., … Migaly, J. (2017). Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer. Ann Surg, 265(4), 774–781. https://doi.org/10.1097/SLA.0000000000001781
Turner, Megan, Mohamed Abdelgadir Adam, Zhifei Sun, Jina Kim, Brian Ezekian, Babatunde Yerokun, Christopher Mantyh, and John Migaly. “Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer.Ann Surg 265, no. 4 (April 2017): 774–81. https://doi.org/10.1097/SLA.0000000000001781.
Turner M, Adam MA, Sun Z, Kim J, Ezekian B, Yerokun B, et al. Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer. Ann Surg. 2017 Apr;265(4):774–81.
Turner, Megan, et al. “Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer.Ann Surg, vol. 265, no. 4, Apr. 2017, pp. 774–81. Pubmed, doi:10.1097/SLA.0000000000001781.
Turner M, Adam MA, Sun Z, Kim J, Ezekian B, Yerokun B, Mantyh C, Migaly J. Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer. Ann Surg. 2017 Apr;265(4):774–781.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

April 2017

Volume

265

Issue

4

Start / End Page

774 / 781

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Rectal Neoplasms
  • Racial Groups
  • Proctoscopy
  • Multivariate Analysis