Minimally invasive surgeries underused with Medicare patients, study says

Many of the procedures have lower rates of complication and readmission, in addition to potentially limiting better care and lower costs for it, report researchers at Johns Hopkins University.
By Allen Cone  |  March 5, 2018 at 10:04 AM
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March 5 (UPI) -- Medicare patients underwent far fewer minimally invasive operations for common procedures compared with the general population, according to a study at Johns Hopkins University.

The disparity, researchers say, could be affecting the quality and cost of care, as well as lowering the outcome of surgical procedures performed on older patients.

Researchers, after examining the medical records 233,984 people with Medicare, concluded that they are experiencing higher rates of complication, hospital readmission and high costs, according to findings published in the journal Surgical Endoscopy.

"This study shows there is an opportunity for Medicare and other payers to spend healthcare dollars more wisely so that they reward high-value care over low-value care," Dr. Martin Makary, professor of surgery at the Johns Hopkins University School of Medicine in Baltimore said in a press release.

Medicare is the federal insurance program for those older than 65, younger disabled people and those with end-stage kidney disease. Spending on the program grew 3.6 percent to $672 billion in 2016, according to the Centers for Medicare & Medicaid Services.

In previous studies, minimally invasive surgeries have been associated with lower postoperative complication rates, readmission rates, mortality and healthcare costs, including shorter lengths of stay at the hospital. These methods nearly eliminate the risk of a wound infection, and cut in half the overall complication rate, according to the research.

Laparoscopy, which is performed through one or more small incisions with small tubes, tiny cameras and surgical instruments, was one of the first types of minimally invasive surgeries available. Another type of minimally invasive surgery is robotic surgery, which provides a magnified 3D view of the surgical site.

For the study, Makary focused on the elderly, using the 2014 Medicare Provider Analysis and Review Inpatient Limited Data Set to identify patients who underwent seven common procedures: gallbladder removal, bariatric surgery, colectomy, hysterectomy, inguinal hernia, thoracic hernia and ventral hernia. In addition, the researchers looked at odds of complications and readmissions for any cause within 30 days.

Among the records examined, 102,729 underwent standard operations and 131,255 had minimally invasive surgery. They found that minimal surgeries were more used among general population patients than by those with Medicare, despite clear benefits.

Among those with the minimally invasive surgery, complication rates were lower for all but the hernia operations and, in six types of the operations, hospital stays were shorter, ranging from one-third to 2-1/2 days. Medicare claims also were smaller for four procedures, and reimbursements were lower for three of the procedures.

Makary said he believes that the study supports the idea that "underuse of MIS for eligible candidates in the Medicare population is an example of low-value care."

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