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Regional variations and deprivation are linked to poorer access to laparoscopic and robotic colorectal surgery: a national study in England
Techniques in Coloproctology ( IF 2.7 ) Pub Date : 2023-12-11 , DOI: 10.1007/s10151-023-02874-3
A J Morton 1, 2 , A Simpson 1 , D J Humes 1, 2
Affiliation  

Background

Laparoscopic and now robotic colorectal surgery has rapidly increased in prevalence; however, little is known about how uptake varies by region and sociodemographics. The aim of this study was to quantify the uptake of minimally invasive colorectal surgery (MIS) over time and variations by region, sociodemographics and ethnicity.

Methods

Retrospective analysis of routinely collected healthcare data (Clinical Practice Research Datalink linked to Hospital Episode Statistics) for all adults having elective colorectal resectional surgery in England from 1 January 2006 to 31 March 2020. Sociodemographics between modalities were compared and the association between sociodemographic factors, region and year on MIS was compared in multivariate logistic regression analysis.

Results

A total of 93,735 patients were included: 52,098 open, 40,622 laparoscopic and 1015 robotic cases. Laparoscopic surgery surpassed open in 2015 but has plateaued; robotic surgery has rapidly increased since 2017, representing 3.2% of cases in 2019. Absolute differences up to 20% in MIS exist between regions, OR 1.77 (95% CI 1.68–1.86) in South Central and OR 0.75 (95% CI 0.72–0.79) in the North West compared to the largest region (West Midlands). MIS was less common in the most compared to least deprived (14.6% of MIS in the most deprived, 24.8% in the least, OR 0.85 95% CI 0.81–0.89), with a greater difference in robotic surgery (13.4% vs 30.5% respectively). Female gender, younger age, less comorbidity, Asian or ‘Other/Mixed’ ethnicity and cancer indication were all associated with increased MIS.

Conclusions

MIS has increased over time, with significant regional and socioeconomic variations. With rapid increases in robotic surgery, national strategies for procurement, implementation, equitable distribution and training must be created to avoid worsening health inequalities.



中文翻译:


地区差异和剥夺与腹腔镜和机器人结直肠手术的机会较差有关:英格兰的一项全国性研究


 背景


腹腔镜和现在的机器人结直肠手术的患病率迅速增加;然而,人们对接种率如何因地区和社会人口统计学而异知之甚少。本研究的目的是量化微创结直肠手术 (MIS) 随时间的采用以及地区、社会人口统计学和种族的变化。

 方法


对 2006 年 1 月 1 日至 2020 年 3 月 31 日期间英格兰所有接受择期结直肠切除术的成年人的常规收集的医疗保健数据(与医院事件统计相关的临床实践研究数据链)进行回顾性分析。比较了模式之间的社会人口统计学,并在多变量 logistic 回归分析中比较了 MIS 的社会人口学因素、地区和年份之间的关联。

 结果


共纳入 93,735 名患者:52,098 名开放病例、40,622 名腹腔镜病例和 1015 名机器人病例。腹腔镜手术在 2015 年超过了开放手术,但已趋于平稳;自 2017 年以来,机器人手术迅速增加,占 2019 年病例的 3.2%。区域之间的 MIS 存在高达 20% 的绝对差异,与最大的区域(西米德兰兹郡)相比,中南部的 OR 为 1.77 (95% CI 1.68-1.86),西北部的 OR 为 0.75 (95% CI 0.72-0.79)。与最不贫困的人群相比,MIS 在最贫困的人群中较少见(最贫困人群为 14.6%,最贫困人群为 24.8%,或 0.85 95% CI 0.81-0.89),机器人手术差异更大(分别为 13.4% 和 30.5%)。女性、年龄较小、合并症较少、亚洲或“其他/混合”种族和癌症适应症都与 MIS 增加相关。

 结论


MIS 随着时间的推移而增加,具有显着的地区和社会经济差异。随着机器人手术的迅速增加,必须制定采购、实施、公平分配和培训的国家战略,以避免健康不平等恶化。

更新日期:2023-12-11
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