BACKGROUND Surgical resection is a mainstay of treatment for colorectal cancer (CRC). Minimally invasive surgery (MIS) has been shown to have improved outcomes compared to open procedures for colorectal malignancy. While use of MIS has been increasing, there remains large variability in its implementation at the hospital and patient level. OBJECTIVE The purpose of this study was to identify disparities in sex, race, location, patient income status, insurance status, hospital region, bed size and teaching status for the use of MIS in the treatment of CRC. METHODS This was a retrospective cohort study using the Nationwide Inpatient Sample Database. Between 2008 and 2017, there were 412,292 hospitalizations of adult patients undergoing elective colectomy for CRC. The primary outcome was use of MIS during hospitalization. RESULTS Overall, the frequency of open colectomies was higher than MIS (56.56% vs. 43.44%). Black patients were associated with decreased odds of MIS use during hospitalization compared to White patients (OR 0.921, p = 0.0011). As the county population where patients resided decreased, odds of MIS also significantly decreased as compared to central counties of metropolitan areas. As income decreased below the reference of $71,000, odds of MIS also significantly decreased. Medicaid and uninsured patients had decreased odds of MIS use during hospitalization compared to private insurance (OR 0.751, p < 0.0001 and OR 0.629, p < 0.0001 respectively). Rural and urban non-teaching hospitals were associated with decreased odds of MIS as compared to urban teaching hospitals (OR 0.523, p < 0.0001 and OR 0.837, p < 0.0001 respectively). Hospitals with a small bed size were also associated with decreased MIS during hospitalizations (OR 0.888, p < 0.0001). CONCLUSIONS Marked hospital level and socioeconomic disparities exist for utilization of MIS for colorectal cancer. Strategies targeted at reducing these gaps have the potential to improve surgical outcomes and cancer survival.

中文翻译：

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十多年来医院因素和社会经济地位与结直肠癌微创手术应用的关联。

背景技术手术切除是结直肠癌(CRC)的主要治疗方法。与结直肠恶性肿瘤的开放手术相比，微创手术 (MIS) 已被证明具有改善的结果。虽然 MIS 的使用一直在增加，但其在医院和患者层面的实施仍然存在很大差异。目的 本研究的目的是确定 MIS 在 CRC 治疗中的性别、种族、地点、患者收入状况、保险状况、医院地区、床位大小和教学状况方面的差异。方法 这是一项使用全国住院患者样本数据库的回顾性队列研究。2008 年至 2017 年间，因结直肠癌接受择期结肠切除术的成年患者住院人数为 412,292 人。主要结果是住院期间使用 MIS。结果总体而言，开放性结肠切除术的频率高于 MIS（56.56% 对 43.44%）。与白人患者相比，黑人患者在住院期间使用 MIS 的几率降低（OR 0.921，p = 0.0011）。随着患者所在县域人口的减少，MIS 的发生率与大城市的中心县相比也显着降低。随着收入低于 71,000 美元的参考值，MIS 的几率也显着降低。与私人保险相比，医疗补助和未投保患者在住院期间使用 MIS 的几率降低（分别为 OR 0.751，p < 0.0001 和 OR 0.629，p < 0.0001）。与城市教学医院相比，农村和城市非教学医院的 MIS 几率降低（分别为 OR 0.523，p < 0.0001 和 OR 0.837，p < 0.0001）。床位较小的医院也与住院期间 MIS 减少有关 (OR 0.888, p < 0.0001)。结论 MIS 在结直肠癌中的应用存在显着的医院水平和社会经济差异。旨在缩小这些差距的策略有可能改善手术结果和癌症存活率。