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National Disparities in Minimally Invasive Surgery for Hepatic Tumors
Oscar Salirrosas, MD
1; Eduardo A. Vega, MD
1; Emeka P. Agudile
2-
3, MD: Elena Panettieri, MD
1-
4; Hamed Harandi, MD
1; Olga Kozyreva, MD
5; Shree Ganta, MD
6; and Claudius Conrad MD, PhD
1 1Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
2Department of Medicine, Steward Carney Hospital, Dorchester, MA, USA
3Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
4Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
5Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA
6Department of Medicine, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
Background: For patients with hepatic tumors, several disparities have been shown to impact access to care, including surgery. The aim of this study was to investigate national disparities in access to minimally invasive surgery (MIS) across different demographic characteristics for patients with hepatic tumors.
Methods: The NCDB was queried for patients with Liver Tumors who underwent surgical resection, either open or MIS approach (robotic or laparoscopic), between January 2010-2020. Patients who were offered a MIS but converted during surgery, were analyzed in MIS group. Patients undergoing total hepatectomy for transplant were excluded. Univariate and Multivariate logistic regression analyses were performed.
Results: The NCDB search identified 18779 patients, 12953 (69%) in the Open group and 5826 (31%) in the MIS group [978(17%) robotic and 4848 (83%) laparoscopic]. Of note, MIS for liver tumors increased from 19% in 2010 to 42% in 2020. Factors associated with receiving MIS included: higher education [OR 1.124 (p=0.011)]. Factors associated with receiving an Open approach included: Black race [OR 0.912 (p=0.046) and urban/rural residence [OR 0.811 (p=0.000)].
Conclusion: While the utilization of MIS is overall increasing in hepatic surgery, there are significant demographic and socioeconomics disparities in the utilization of it compared to the Open approach. The benefits of MIS should not be limited to specific socioeconomic cohorts of the population. Recognizing these disparities is a necessary first step in providing equal care.
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