Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study



Moss, Esther L, Morgan, George, Martin, Antony P ORCID: 0000-0003-4383-6038, Sarhanis, Panos and Ind, Thomas
(2020) Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study. BMJ Open, 10 (9). e036222-.

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Abstract

<h4>Objective</h4>To examine surgical outcomes and trends in the implementation of minimally invasive surgery (MIS) use for endometrial cancer (EC).<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>English National Health Service hospitals 2011-2017/2018.<h4>Population</h4>35 304 patients having a hysterectomy for EC identified from Hospital Episode Statistics.<h4>Methods</h4>Univariate and multivariate analyses compared MIS to open hysterectomy (OH) by assessing the association between demographic, clinical and hospital characteristics by using logistic regression. A propensity score was created, to control for confounding factors including demographics, clinical and hospital characteristics, from a logistic regression which enabled the inverse probability weighting of treatment to be applied in order to compare outcomes of treatment.<h4>Main outcome measures</h4>The association between route of surgery on perioperative morbidity and mortality.<h4>Results</h4>The MIS rate rose from 40.3% in 2011 to 68.7% in 2017/2018, however, there was significant geographical variation (p<0.001). The overall 90-day mortality was significantly higher with OH versus MIS (OR 0.34, 95% CI 0.18 to 0.62, p=0.0002). MIS rates were significantly lower in patients from the lowest socioeconomic group (LSEG) compared with patients from the highest group (HSEG) (55.4% vs 59.9%, p<0.01), and in the black population as compared with white and Asian populations (40.4% vs 58.6% and 56.0%, p<0.0001). When patients from LSEG and black patients were treated in hospitals with high MIS rates, the MIS rate increased close to that of the HSEG and white patients (81.0% and 74.1% vs 83.2% and 82.6%).<h4>Conclusions</h4>Further investigation is needed to understand the barriers to MIS and improve access so that as many patients as possible can benefit from the reduced morbidity/mortality associated with MIS.

Item Type: Article
Uncontrolled Keywords: gynaecological oncology, minimally invasive surgery, surgery, quality in health care, change management
Depositing User: Symplectic Admin
Date Deposited: 19 Oct 2020 09:39
Last Modified: 18 Jan 2023 23:28
DOI: 10.1136/bmjopen-2019-036222
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3104388