Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer
Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer
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保险状况而非种族与直肠癌微创手术方法的使用相关
DOI：
10.1097/sla.0000000000001781
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发表时间：
2017
影响因子：
9
通讯作者：
J. Migaly
中科院分区：
文献类型：
--
作者：
M. Turner;M. Adam;Zhifei Sun;Jina Kim;B. Ezekian;Babatunde Yerokun;C. Mantyh;J. Migaly
目的：确定种族和保险对美国直肠癌微创（MIS）与开放技术使用的影响。背景：种族和社会经济地位与直肠癌治疗的差异有关。研究方法：从国家癌症数据库（2010-2012）中纳入了接受MIS（腹腔镜或机器人）或开放性直肠切除术治疗I至III期直肠腺癌的成人。采用多变量分析来研究种族和保险与MIS和开放手术的校正相关性。结果：在23，274例患者中，39%接受了MIS，61%接受了开放手术。总体而言，86%是白色，8%是黑人，3%是亚洲人。与使用开放式与MIS相关的因素是黑人种族、医疗保险/医疗补助保险和缺乏保险。然而，在对患者人口统计学、临床和治疗特征进行调整后，黑人与MIS与开放手术的使用无关[比值比[OR] 0.90，P = 0.07]。与私人保险患者相比，未保险患者（OR 0.52，P < 0.01）和医疗保险/医疗补助患者（OR 0.79，P < 0.01）不太可能接受微创切除术。在黑人（OR 0.59，P = 0.02）或白色患者（OR 0.51，P < 0.01）中，缺乏保险与MIS的使用率显著相关。然而，在没有保险的患者中，黑人与MIS的使用率较低无关（OR 0.96，P = 0.59）。结论：保险状况，而非种族，与肿瘤学直肠切除术中微创技术的使用相关。由于微创技术的短期效益和成本效益，医院可能需要改善这些技术的可及性，特别是对于没有保险的患者。
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.
影响因子：
120.7
作者：
Fleshman, James;Branda, Megan;Sargent, Daniel J.;Boller, Anne Marie;George, Virgilio;Abbas, Maher;Peters, Walter R., Jr.;Maun, Dipen;Chang, George;Herline, Alan;Fichera, Alessandro;Mutch, Matthew;Wexner, Steven;Whiteford, Mark;Marks, John;Birnbaum, Elisa;Margolin, David;Larson, David;Marcello, Peter;Posner, Mitchell;Read, Thomas;Monson, John;Wren, Sherry M.;Pisters, Peter W. T.;Nelson, Heidi
通讯作者：
Nelson, Heidi