Disparities in access to basic laparoscopic surgery at U.S. academic medical centers.

Background: Laparoscopy is the standard approach used for basic gastrointestinal procedures such appendectomy and cholecystectomy. This study determined the disparities in access to laparoscopic surgery for these commonly performed procedures at U.S. academic medical centers.

Methods: Using appropriate International Classification of Diseases, 9th ed, Clinical Modification (ICD-9-CM) procedure and diagnosis codes, 112,540 basic gastrointestinal procedures were identified from the University HealthSystem Consortium database over a 4-year period (2005-2009). During this period, 82,062 laparoscopic (72.9%) and 30,478 open (27.1%) procedures were performed. The odds ratios (ORs) for laparoscopic versus open procedures were calculated and stratified for age, gender, race/ethnicity, admission status, severity of illness, and primary payer status.

Results: Univariate analysis showed that young age (OR, 1.33; 95% confidence interval [CI], 1.27-1.39), white race/ethnicity (OR, 1.07; 95% CI, 1.03-1.11), female gender (OR, 1.79; 95% CI, 1.75-1.84), minor severity of illness (OR, 1.49; 95% CI, 1.44-1.53), and commercial/private payer status (OR, 1.25; 95% CI, 1.21-1.29) increased the likelihood that a laparoscopic approach would be used for the procedures studied.

Conclusion: A disparity in access to basic laparoscopic surgery exists at U.S. academic medical centers based on age, gender, race/ethnicity, severity of illness, and primary payer status.