Regional variations and deprivation are linked to poorer access to laparoscopic and robotic colorectal surgery: a national study in England

Morton, A. J.; Simpson, A.; Humes, D. J.

Abstract

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.

Citation

Morton, A. J., Simpson, A., & Humes, D. J. (2024). Regional variations and deprivation are linked to poorer access to laparoscopic and robotic colorectal surgery: a national study in England. Techniques in Coloproctology, 28(1), Article 9. https://doi.org/10.1007/s10151-023-02874-3

• Journal Article Type: Article
• Acceptance Date: Oct 18, 2023
• Online Publication Date: Dec 11, 2023
• Publication Date: 2024
• Deposit Date: Jan 8, 2024
• Publicly Available Date: Jan 10, 2024
• Journal: Techniques in Coloproctology
• Print ISSN: 1123-6337
• Electronic ISSN: 1128-045X
• Publisher: Springer Nature
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Issue: 1
• Article Number: 9
• DOI: https://doi.org/10.1007/s10151-023-02874-3
• Keywords: Minimally invasive surgical procedures, Colorectal surgery, Laparoscopy, Robotic surgical procedures, Health inequalities
• Public URL: https://nottingham-repository.worktribe.com/output/28701526
• Publisher URL: https://link.springer.com/article/10.1007/s10151-023-02874-3
• Additional Information: Received: 7 July 2023; Accepted: 18 October 2023; First Online: 11 December 2023; : ; : A. Simpson is a proctor for the Intuitive Robotic Training Programme. This work was funded by the Intuitive Foundation grant number 5526921.; : The study was approved by the Independent Scientific Advisory Committee via the CPRD electronic Research Applications Portal (ID 21_000572).; : None required—anonymised routinely collected data.