Minimally invasive surgical procedures can halve the risk for postoperative complications compared with open procedures, but they are still getting used infrequently in lots of hospitals, outcomes of a retrospective study suggest. Using minimally invasive procedures varies widely in with urban hospitals being greater than 4 times as likely as rural hospitals. 

 

Utilization of non-invasive procedures also varied by hospital size, teaching hospital status, and geographic region. Rural hospitals were less likely to perform non-invasive surgery for 3 from the four procedures studied (appendectomy, colectomy, and hysterectomy, your fourth being lobe lobectomy). This disparity may be due towards the wide range of surgical services some surgeons in rural areas are required to provide along with a scarcity of surgical specialists such areas with advanced skills in minimally invasive surgery.

 

Inside a study published online July 8 in BMJ. The researchers analyzed records of the nationwide inpatient sample database in the US Agency for Healthcare and Research Quality to find out use rates and patterns of the 4 common surgical procedures. The data set included information on a representative sample of patients discharged from 1051 hospitals in 45 states in 2010. They made a decision to look at records for several procedures supported by a strong evidence base (laparoscopic appendectomy, partial colectomy, and total abdominal hysterectomy) and 1 that the advantages of a non-invasive procedure vs an open procedure are less certain (thorascopic lung lobectomy).

It is found that there was "sharp discordance" between the predicted and actual use of procedures performed with a non-invasive technique, the study's primary endpoint. For example, the predicted number of appendectomies performed each and every hospital fell in the range of 60% to 80%, but a small amount of hospitals actually performed no non-invasive appendectomies, whereas several performed only laparoscopic appendectomies. 

 

Less Invasive, Fewer Complications Hospital factors significantly related to high utilization of at least 1 non-invasive procedure included urban setting, large size, and teaching hospital. Teaching hospitals were considerably less likely, however, to do minimally invasive colectomies.

 

Regardless of the lower complication rates and faster patient recovery times related to minimally invasive procedures, some patients are not appropriate candidates for such a task, and some surgeons prefer for a number of good reasons to stick to the greater invasive open techniques. Nonetheless, many hospitals come with an opportunity to decrease surgical complications by increasing utilization of minimally invasive surgery. 

 

Important ways to cope with this disparity may be more standardized postgraduate training, training of surgeons currently used, transparency of hospital rates of utilization of non-invasive surgery, and information for patients.