ArticleBMJ (Clinical research ed.)2014
Hospital level under-utilization of minimally invasive surgery in the United States: retrospective review.
Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Comparing Open, Laparoscopic and Robotic Liver Resection for Metastatic Colorectal Cancer-A Systematic Review and Network Meta-Analysis.Journal of surgical oncology · 2025Pooled it
- Minimally Invasive and Open Gastrectomy for Gastric Cancer: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.Annals of surgical oncology · 2023Pooled it
- Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials.Langenbeck's archives of surgery · 2023Pooled it
- Racial Disparities in Minimally Invasive Benign Hysterectomy.JSLS : Journal of the Society of Laparoendoscopic SurgeonsPooled it
- Interim safety analysis of the first-in-human clinical trial of the Versius surgical system, a new robot-assisted device for use in minimal access surgery.Surgical endoscopy · 2021Trial
- Physiological correlates of cognitive load in laparoscopic surgery.Scientific reports · 2020Trial
- Association Between Surgical Robotic Availability and Open Operation Rate: A Geographic Analysis.Journal of the American College of Surgeons · 2026Article
- Healing Beyond the Operating Room: Bedside Strategies for Necrotizing Fasciitis.The American journal of case reports · 2026Article
- Financial incentives and work relative value unit comparison of fixation versus total elbow arthroplasty for distal humerus fractures.Clinics in shoulder and elbow · 2025Article
- Improved performance and design of a low-cost laparoscope to enable laparoscopic surgery in low-income countries.Biophotonics discovery · 2025Article
- Rates of Minimally Invasive Surgery After Introduction of Robotic-Assisted Surgery for Common General Surgery Operations.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Investigating Racial, Ethnic, and Socioeconomic Disparities in Pelvic Organ Prolapse Surgery.Urogynecology (Philadelphia, Pa.) · 2025Article
- Research Trends and Hotspots in Minimally Invasive Gynecologic Surgery: A Bibliometric and Visualization Analysis.International journal of women's health · 2025Review
- Measuring hospital inpatient Procedure Access Inequality in the United States.Health affairs scholar · 2024Article
- Racial and ethnic disparities in robot-assisted radical prostatectomy: testing the physician-level segregated and differential treatment hypotheses.JNCI cancer spectrum · 2024Observational
- Satisfaction of surgeons with the current state of training in minimally invasive surgery: a survey among German surgeons.Surgical endoscopy · 2024Article
- Minimal Invasive Versus Open Surgery for Colorectal Liver Metastases: A Multicenter German StuDoQ|Liver Registry-Based Cohort Analysis in Germany.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2023Article
- Early evaluation of a next-generation surgical system in robot-assisted total laparoscopic hysterectomy: A prospective clinical cohort study.Acta obstetricia et gynecologica Scandinavica · 2022Article
- Association of hospital factors and socioeconomic status with the utilization of minimally invasive surgery for colorectal cancer over a decade.Surgical endoscopy · 2022Article
- Disparities in Utilization and Outcomes of Minimally Invasive Techniques for Gastric Cancer Surgery in the United States.Annals of surgical oncology · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo determine casemix adjusted hospital level utilization of minimally invasive surgery for four common surgical procedures (appendectomy, colectomy, total abdominal hysterectomy, and lung lobectomy) in the United States.
designRetrospective review.
settingUnited States.
participantsNationwide inpatient sample database, United States 2010.
methodsFor each procedure, a propensity score model was used to calculate the predicted proportion of minimally invasive operations for each hospital based on patient characteristics. For each procedure, hospitals were categorized into thirds (low, medium, and high) based on their actual to predicted proportion of utilization of minimally invasive surgery.
main outcome measuresThe primary outcome measures were the actual and predicted proportion of procedures performed with minimally invasive surgery. Secondary outcome measures included surgical complications and hospital characteristics.
resultsMean hospital utilization of minimally invasive surgery was 71.0% (423/596) for appendectomy (range 40.9-93.1% (244-555)), 28.4% (154/541) for colectomy (6.7-49.8% (36/541-269/541)), 13.0% (65/499) for hysterectomy (0.0-33.6% (0/499-168/499)), and 32.0% (67/208) for lung lobectomy (3.6-65.7% (7.5/208-137/208)). Utilization of minimally invasive surgery was highly variable for each procedure type. There was noticeable discordance between actual and predicted utilization of the surgery (range of actual to predicted ratio for appendectomy 0-1.49; colectomy 0-3.88; hysterectomy 0-6.68; lung lobectomy 0-2.51). Surgical complications were less common with minimally invasive surgery compared with open surgery, respectively: overall rate for appendectomy 3.94% (1439/36,513) v 7.90% (958/12,123), P<0.001; for colectomy: 13.8% (1689/12,242) v 35.8% (8837/24,687), P<0.001; for hysterectomy: 4.69% (270/5757) v 6.64% (1988/29,940), P<0.001; and for lung lobectomy: 17.1% (367/2145) v 25.4% (971/3824), P<0.05. High utilization of minimally invasive surgery was associated with urban location (appendectomy: odds ratio 4.66, 95% confidence interval 1.17 to 18.5; colectomy: 4.59, 1.04 to 20.3; hysterectomy: 15.0, 2.98 to 75.0), large hospital size (hysterectomy: 8.70, 1.62 to 46.8), teaching hospital (hysterectomy: 5.41, 1.27 to 23.1), Midwest region (appendectomy: 7.85, 1.26 to 49.1), south region (appendectomy: 21.0, 3.79 to 117; colectomy: 10.0, 1.83 to 54.7), and west region (appendectomy: 9.33, 1.48 to 58.8).
conclusionHospital utilization of minimally invasive surgery for appendectomy, colectomy, total abdominal hysterectomy, and lung lobectomy varies widely in the United States, representing a disparity in the surgical care delivered nationwide.
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