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The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes.
Surg Endosc. 2016 08; 30(8):3321-6.SE

Abstract

BACKGROUND

Population-based studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections. As such, data assessing non-elective laparoscopic colectomies are limited. Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USA.

METHODS

A national inpatient database was reviewed from 2008 to 2011 for right, left, and sigmoid colectomies in the non-elective setting. Cases were stratified by approach into open or laparoscopic groups. Demographics, perioperative clinical variables, and financial outcomes were compared across each group.

RESULTS

A total of 22,719 non-elective colectomies were analyzed. The vast majority (95.8 %) was open. Most cases were performed in an urban setting at non-teaching hospitals by general surgeons. Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons (p < 0.001). Demographics were similar between open and laparoscopic groups; however, the disease distribution by approach varied, with significantly more severe cases in the open colectomy arm (p < 0.001). Cases performed laparoscopically had significantly better mortality and complication rates. Laparoscopic cases also had significantly improved outcomes, including shorter length of stay and hospital costs (all p < 0.001).

CONCLUSIONS

Our analysis revealed less than 5 % of urgent and emergent colectomies in the USA are performed laparoscopically. Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons. Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication rates, and lower costs. Increased adoption of laparoscopy in the non-elective setting should be considered.

Authors+Show Affiliations

Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. debby_keller@hotmail.com.Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA.Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA. Houston Methodist Hospital, Houston, TX, USA.Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA. Houston Methodist Hospital, Houston, TX, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26490770

Citation

Keller, Deborah S., et al. "The Current Status of Emergent Laparoscopic Colectomy: a Population-based Study of Clinical and Financial Outcomes." Surgical Endoscopy, vol. 30, no. 8, 2016, pp. 3321-6.
Keller DS, Pedraza R, Flores-Gonzalez JR, et al. The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes. Surg Endosc. 2016;30(8):3321-6.
Keller, D. S., Pedraza, R., Flores-Gonzalez, J. R., LeFave, J. P., Mahmood, A., & Haas, E. M. (2016). The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes. Surgical Endoscopy, 30(8), 3321-6. https://doi.org/10.1007/s00464-015-4605-z
Keller DS, et al. The Current Status of Emergent Laparoscopic Colectomy: a Population-based Study of Clinical and Financial Outcomes. Surg Endosc. 2016;30(8):3321-6. PubMed PMID: 26490770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes. AU - Keller,Deborah S, AU - Pedraza,Rodrigo, AU - Flores-Gonzalez,Juan Ramon, AU - LeFave,Jean Paul, AU - Mahmood,Ali, AU - Haas,Eric M, Y1 - 2015/10/21/ PY - 2015/05/02/received PY - 2015/09/28/accepted PY - 2015/10/23/entrez PY - 2015/10/23/pubmed PY - 2017/8/3/medline KW - Colon and rectal surgery KW - Emergency surgery KW - Emergent colectomy KW - Healthcare outcomes KW - Laparoscopic surgery SP - 3321 EP - 6 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 8 N2 - BACKGROUND: Population-based studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections. As such, data assessing non-elective laparoscopic colectomies are limited. Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USA. METHODS: A national inpatient database was reviewed from 2008 to 2011 for right, left, and sigmoid colectomies in the non-elective setting. Cases were stratified by approach into open or laparoscopic groups. Demographics, perioperative clinical variables, and financial outcomes were compared across each group. RESULTS: A total of 22,719 non-elective colectomies were analyzed. The vast majority (95.8 %) was open. Most cases were performed in an urban setting at non-teaching hospitals by general surgeons. Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons (p < 0.001). Demographics were similar between open and laparoscopic groups; however, the disease distribution by approach varied, with significantly more severe cases in the open colectomy arm (p < 0.001). Cases performed laparoscopically had significantly better mortality and complication rates. Laparoscopic cases also had significantly improved outcomes, including shorter length of stay and hospital costs (all p < 0.001). CONCLUSIONS: Our analysis revealed less than 5 % of urgent and emergent colectomies in the USA are performed laparoscopically. Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons. Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication rates, and lower costs. Increased adoption of laparoscopy in the non-elective setting should be considered. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26490770/full_citation L2 - https://doi.org/10.1007/s00464-015-4605-z DB - PRIME DP - Unbound Medicine ER -