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Do specific operative approaches and insurance status impact timely access to colorectal cancer care?

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

The increased use of minimally invasive surgery in the management of colorectal cancer has led to a renewed focus on how certain factors, such as insurance status, impact the equitable distribution of both laparoscopic and robotic surgery. Our goal was to analyze surgical wait times between robotic, laparoscopic, and open approaches, and to determine whether insurance status impacts timely access to treatment.

Methods

After IRB approval, adult patients from the National Cancer Database with a diagnosis of colorectal cancer were identified (2010–2016). Patients who underwent radiation therapy, neoadjuvant chemotherapy, had wait times of 0 days from diagnosis to surgery, or had metastatic disease were excluded. Primary outcomes were days from cancer diagnosis to surgery and days from surgery to adjuvant chemotherapy. Multivariable Poisson regression analysis was performed.

Results

Among 324,784 patients, 5.9% underwent robotic, 47.5% laparoscopic, and 46.7% open surgery. Patients undergoing robotic surgery incurred the longest wait times from diagnosis to surgery (29.5 days [robotic] vs. 21.7 [laparoscopic] vs. 17.2 [open], p < 0.001), but the shortest wait times from surgery to adjuvant chemotherapy (48.9 days [robotic] vs. 49.9 [laparoscopic] vs. 54.8 [open], p < 0.001). On adjusted analysis, robotic surgery was associated with a 1.46 × longer wait time to surgery (IRR 1.462, 95% CI 1.458–1.467, p < 0.001), but decreased wait time to adjuvant chemotherapy (IRR 0.909, 95% CI 0.905–0.913, p < 0.001) compared to an open approach. Private insurance was associated with decreased wait times to surgery (IRR 0.966, 95% CI 0.962–0.969, p < 0.001) and adjuvant chemotherapy (IRR 0.862, 95% CI 0.858–0.865, p < 0.001) compared to Medicaid.

Conclusion

Though patients undergoing robotic surgery experienced delays from diagnosis to surgery, they tended to initiate adjuvant chemotherapy sooner compared to those undergoing open or laparoscopic approaches. Private insurance was independently associated not only with access to robotic surgery, but also shorter wait times during all stages of treatment.

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Data availability

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Acknowledgements

Mr. Edwin Lewis has provided generous support for Dr. Efron’s Department of Surgery Research Fund.

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Authors and Affiliations

  1. Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA

    Brian D. Lo, George Q. Zhang, Miloslawa Stem, Rebecca Sahyoun, Jonathan E. Efron, Bashar Safar & Chady Atallah

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  1. Brian D. Lo
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Correspondence to Chady Atallah.

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Dr. Bashar Safar reports receiving lecture payments from Johnson and Johnson. Mr. Brian D. Lo, Mr. George Q. Zhang, Ms. Miloslawa Stem, Dr. Rebecca Sahyoun, Dr. Jonathan E. Efron, and Dr. Chady Atallah have no conflicts of interest or financial ties to disclose.

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Lo, B.D., Zhang, G.Q., Stem, M. et al. Do specific operative approaches and insurance status impact timely access to colorectal cancer care?. Surg Endosc 35, 3774–3786 (2021). https://doi.org/10.1007/s00464-020-07870-4

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  • DOI: https://doi.org/10.1007/s00464-020-07870-4

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