• Amanda N Fader, R Matsuno Weise, Abdulrahman K Sinno, Edward J Tanner, Bijan J Borah, James P Moriarty, Robert E Bristow, Martin A Makary, Peter J Pronovost, Susan Hutfless, and Sean C Dowdy.
• Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, the Department of Surgery, and the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Baltimore, Maryland; the University of California San Diego Medical Group, La Jolla, and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California; and the Division of Health Care Policy & Research and the Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.
• Obstet Gynecol. 2016 Jan 1; 127 (1): 91-100.

ObjectiveTo describe case mix-adjusted hospital level utilization of minimally invasive surgery for hysterectomy in the treatment of early-stage endometrial cancer.MethodsIn this retrospective cohort study, we analyzed the proportion of patients who had a minimally invasive compared with open hysterectomy for nonmetastatic endometrial cancer using the U.S. Nationwide Inpatient Sample database, 2007-2011. Hospitals were stratified by endometrial cancer case volumes (low=less than 10; medium=11-30; high=greater than 30 cases). Hierarchical logistic regression models were used to evaluate hospital and patient variables associated with minimally invasive utilization, complications, and costs.ResultsOverall, 32,560 patients were identified; 33.6% underwent a minimally invasive hysterectomy with an increase of 22.0-50.8% from 2007 to 2011. Low-volume cancer centers demonstrated the lowest minimally invasive utilization rate (23.6%; P<.001). After multivariable adjustment, minimally invasive surgery was less likely to be performed in patients with Medicaid compared with private insurance (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.62-0.72), black and Hispanic compared with white patients (adjusted OR 0.43, 95% CI 0.41-0.46 for black and 0.77, 95% CI 0.72-0.82 for white patients), and more likely to be performed in high- compared with low-volume hospitals (adjusted OR 4.22, 95% CI 2.15-8.27). Open hysterectomy was associated with a higher risk of surgical site infection (adjusted OR 6.21, 95% CI 5.11-7.54) and venous thromboembolism (adjusted OR 3.65, 95% CI 3.12-4.27). Surgical cases with complications had higher mean hospitalization costs for all hysterectomy procedure types (P<.001).ConclusionHospital utilization of minimally invasive surgery for the treatment of endometrial cancer varies considerably in the United States, representing a disparity in the quality and cost of surgical care delivered nationwide.

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