Uptake and patient outcomes of laparoscopic colon and rectal cancer surgery in a publicly funded system and following financial incentives

Ann Surg Oncol. 2013 Nov;20(12):3740-6. doi: 10.1245/s10434-013-3123-2. Epub 2013 Jul 13.


Purpose: To assess patterns of uptake and outcomes of laparoscopic colon and rectal cancer surgery in Ontario, and the potential influence of surgical fee incentives instituted on October 1, 2005.

Methods: We used Ontario administrative databases from fiscal years 2002 to 2009. Study outcomes were uptake rates of laparoscopic surgery, hospital length of stay, 30-day operative mortality, cancer-specific survival, and overall survival. The main descriptor for multivariable regression models was a 5% increase in rate of laparoscopic colon cancer surgery in the previous year.

Results: The annual rate of laparoscopic colon and rectal cancer surgery, respectively, rose from 8.7 to 38.9% and from 4.8 to 19.6%. The greatest increase in rate of laparoscopic colon surgery occurred shortly after October 1, 2005. For each 5% increase in rate of laparoscopic surgery, the odds of 30-day mortality was 1.0 [95% confidence interval (CI) 0.96-1.01, p = 0.264], the hazard of cancer-specific survival was 1.0 (95% CI 0.97-1.00, p = 0.139), the hazard of overall survival was 1.0 (95% CI 0.98-1.00, p = 0.051), and length of hospital stay was lower (estimate = -0.10, 95% CI -0.14 to -0.06, p < 0.001).

Conclusions: In Ontario by the year 2009, 39% of colon and 20% of rectal cancer surgery was provided laparoscopically. Increased rates were associated with a minimal decrease in hospital length of stay and no changes in 30-day mortality, cancer-specific survival, or overall survival. Financial incentives were likely responsible for the marked increase in laparoscopic colon cancer surgery observed after October 1, 2005.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cohort Studies
  • Colonic Neoplasms / economics
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / surgery*
  • Digestive System Surgical Procedures*
  • Female
  • Financing, Government*
  • Follow-Up Studies
  • Humans
  • Laparoscopy*
  • Length of Stay
  • Male
  • Middle Aged
  • Ontario
  • Outcome Assessment, Health Care*
  • Postoperative Complications
  • Rectal Neoplasms / economics
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / surgery*
  • Reimbursement, Incentive*
  • Survival Rate