Previous research has established that there are many benefits to minimally invasive surgery as opposed to traditional open surgery. It often results in quicker recovery times, decreased pain and reduced rates of post-operative infection.
A new study published by BMJ reports, however, that in hospitals across the US there is a discrepancy in how frequently minimally invasive procedures are utilized instead of open methods, despite the positive record that minimally invasive procedures have.
A common form of minimally invasive surgery is a technique called laparoscopic surgery, which is sometimes referred to as keyhole surgery. Rather than making one large incision as used in traditional open surgery, tubes are inserted into small incisions through which surgical instruments can be inserted. Instruments can be deployed through the tubes to manipulate, cut and sew tissue, as well as to look around inside the body.
Surgical complications are a risk to patients, both physically and financially. In the US they are believed to cost $25 billion every year. However, some surgical complications can be reduced through the utilization of minimally invasive surgery.
Minimally invasive surgery not always an option
Despite the overwhelming evidence in favor of the wide utilization of minimally invasive surgical procedures, some hospitals and surgeons are reported to only provide the option of open surgery, meaning that patients who would otherwise be suitable for minimally invasive surgery are missing out.
Some surgeons do not offer to perform minimally invasive surgery, citing a lack of training and inadequate operative experience.
The scale of variation in the use of minimally invasive surgery as a disparity in US health care is a view that has not been well documented previously, according to researchers based at Johns Hopkins University, Baltimore. As a result, they set out to examine the levels of variation across the country.
To do this, the team took four commonly performed surgical procedures (appendectomy, colectomy, hysterectomy and lung lobectomy) and investigated how frequently minimally invasive surgery was used to carry them out at more than 1,000 hospitals in 2010.
The researchers created a model for each procedure to calculate for each hospital a predicted proportion of operations that would use minimally invasive techniques. The model would be based upon the characteristics of each hospital's patient population.
The researchers found the following average rates of minimally invasive surgery:
- Appendectomy - 71%
- Colectomy - 28%
- Hysterectomy - 13%
- Lung lobectomy - 32%.
The utilization of minimally invasive surgery varied greatly for each procedure. Some hospitals never used minimally invasive surgery for certain operations, while other hospitals utilized minimally invasive surgery for the majority of cases.
The team found that there was significant discordance between their predictions and the actual levels of utilization of minimally invasive surgery for each procedure.
While urban (rather than rural) hospitals were found to be more likely to use minimally invasive surgery for three of the four procedures, the researchers could find no association between other hospital characteristics, such as geography and size, with the use of minimally invasive surgery.
'Two standards of care'
Dr. Martin Makary, senior author of the study and a Johns Hopkins Professor of surgery, says these results represent "a disparity in the surgical care delivered nationwide."
He and his co-authors write that, despite the established benefits of minimally invasive surgery, "two standards of care remain in existence because patient candidacy and the choice of operation are often discretionary, based on surgeon preference."
In their study, the authors theorize that the underperformance of minimally invasive surgery could be due to a variability in appropriate training. They cite a lack of formal training and adequate operative time as reasons why some surgeons did not offer the choice of minimally invasive surgery.
The authors suggest that this could be remedied through more standardized postgraduate training and further training for surgeons who are currently in practice. In addition to these suggestions, they write that better information for patients and transparency of hospital rates of utilization of minimally invasive surgery could also lead to improvements.
They conclude by stating that this is an area that could prove beneficial to monitor in the future:
"Hospital utilization of minimally invasive surgery by procedure may be a meaningful process measure in health care to complement existing and maturing outcome measures of surgical care."
Previously, Medical News Today reported on a historic minimally invasive surgical procedure, when surgeons performed the first ever totally endoscopic aortic valve replacement.
Written by James McIntosh