Uptake and patient outcomes of laparoscopic colon and rectal cancer surgery in a publicly funded system and following financial incentives

Abstract

Purpose: To assess patterns of uptake and outcomes of laparoscopic colon and rectal cancer surgery in Ontario, and the potential influence of surgical fee incentives instituted on October 1, 2005. Methods: We used Ontario administrative databases from fiscal years 2002 to 2009. Study outcomes were uptake rates of laparoscopic surgery, hospital length of stay, 30-day operative mortality, cancer-specific survival, and overall survival. The main descriptor for multivariable regression models was a 5 % increase in rate of laparoscopic colon cancer surgery in the previous year. Results: The annual rate of laparoscopic colon and rectal cancer surgery, respectively, rose from 8.7 to 38.9 % and from 4.8 to 19.6 %. The greatest increase in rate of laparoscopic colon surgery occurred shortly after October 1, 2005. For each 5 % increase in rate of laparoscopic surgery, the odds of 30-day mortality was 1.0 [95 % confidence interval (CI) 0.96-1.01, p = 0.264], the hazard of cancer-specific survival was 1.0 (95 % CI 0.97-1.00, p = 0.139), the hazard of overall survival was 1.0 (95 % CI 0.98-1.00, p = 0.051), and length of hospital stay was lower (estimate = -0.10, 95 % CI -0.14 to -0.06, p < 0.001). Conclusions: In Ontario by the year 2009, 39 % of colon and 20 % of rectal cancer surgery was provided laparoscopically. Increased rates were associated with a minimal decrease in hospital length of stay and no changes in 30-day mortality, cancer-specific survival, or overall survival. Financial incentives were likely responsible for the marked increase in laparoscopic colon cancer surgery observed after October 1, 2005. © 2013 Society of Surgical Oncology.