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BACKGROUND: Morbidity and mortality rates for major surgical procedures are improved in high volume hospitals. Additionally, high volume centers are often leaders in the utilization of novel surgical technology such as minimally invasive surgery (MIS) for colorectal disease. Although high volume centers often serve diverse patient populations, it is unknown if there are disparities in the application of new surgical technologies within these hospitals. We sought to determine if ethnic and socioeconomic disparities in the use of MIS for colorectal disease exist at high volume centers. METHODS: Using the 2008 National Inpatient Sample database, a retrospective review of laparoscopic colectomies performed at high volume centers (case volume >200 year) was conducted. ICD-9 codes were used to identify minimally invasive (MIS) colorectal resections. Multivariate logistic regression including ethnic and socioeconomic variables was used to identify independent predictive factors for undergoing MIS. RESULTS: A total of 98,047 colorectal resections were performed at high volume centers in 2008. Overall, only 7950 (8.1%) colorectal resections were performed using a minimally invasive approach. Patients with malignant neoplasms were three times more likely to undergo MIS and those receiving elective resections were twice as likely (Table1). When evaluating racial and socioeconomic factors, patients within the highest income quartile were more likely to undergo minimally invasive surgery than those in the lowest income groups. In addition, Medicaid and Medicare patients were significantly less likely to undergo MIS. Lastly, race was not a significant predictive factor for undergoing MIS for colorectal disease at a high volume center. CONCLUSION: There are significant socioeconomic disparities in the use of minimally invasive surgery for colorectal disease at high volume centers. Future studies should be aimed at identifying access barriers to MIS in the treatment of colorectal disease.

VARIABLE	OR	CONFIDENCE INTERVAL	P-VALUE
Colorectal Cancer	3.21	2.51-4.10	<0.001
Elective Resection	2.26	1.82-2.80	<0.001
RACE
Caucasian	Ref.
African American	0.97	0.76-1.24	0.79
Hispanic	1.24	0.88-1.75	0.22
PRIMARY PAYER
Private	Ref.
Medicare	0.86	0.74-1.0	0.05
Medicaid	0.48	0.33-0.68	<0.001
MEDIAN HOUSEHOLD INCOME
I: \ - \,999	0.72	0.58-0.91	0.005
II:\,000 - \,999	0.73	0.60-0.90	0.003
III: \,000-\,999	0.87	0.74-1.02	0.086
IV:≥ \,000	Ref.

Table 1. Multivariate logistic regression analyzing predictive factors for undergoing MIS vs. Open resection. (Ref.= Open Surgery)