Dramatic Decreases in Mortality From Laparoscopic Colon Resections Based on Data From the Nationwide Inpatient Sample

Cone, Molly M.; Herzig, Daniel O.; Diggs, Brian S.; Dolan, James P.; Rea, Jennifer D.; Deveney, Karen E.; Lu, Kim C.

doi:10.1001/archsurg.2011.79

Cited by 56 publications

(41 citation statements)

References 34 publications

(25 reference statements)

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“…14–16 This difference may be related to several factors. First, the identification of laparoscopy cases has changed since these prior studies were conducted.…”

Section: Discussionmentioning

confidence: 99%

“…12 This is particularly important as advanced surgical procedures may be associated with more frequent intra-operative complications during early phases of adoption. 13 The most recent reports evaluating outcomes in clinical practice suggested laparoscopy was associated with a substantial reduction in mortality 14 and overall morbidity 15–16 compared to open surgery. However, these reports may have been susceptible to bias through an inability to accurately identify laparoscopic cases.…”

Section: Introductionmentioning

confidence: 99%

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Hospital-Level Outcomes Associated with Laparoscopic Colectomy for Cancer in the Minimally Invasive Era

Fox

Desai

Krumholz

et al. 2012

Journal of Gastrointestinal Surgery

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Background Compared to the open approach, randomized trials have shown that laparoscopic colectomy is associated with a shorter hospitalization without increases in morbidity or mortality rates. With broader adoption of laparoscopic colectomy for cancer in the United States, it is unclear if laparoscopic colectomy continues to be associated with shorter hospitalization and comparable morbidity. Purpose To determine if hospitals where a greater proportion of colon resections for cancer are approached laparoscopically (laparoscopy rate) achieve improved short-term outcomes compared to hospitals with lower laparoscopy rates. Methods From the 2008–2009 Nationwide Inpatient Sample, we identified hospitals where ≤12 colon resections for cancer where reported with ≥1 approached laparoscopically. We assessed the correlation between a hospital’s laparoscopy rate and risk-standardized outcomes (intra- and post-operative morbidity, in-hospital mortality rates, and average length of stay). Results Overall, 6,806 colon resections were performed at 276 hospitals. Variation was noted in hospital laparoscopy rates (median=52.0%, range=3.8–100%) and risk-standardized intra- (2.7%, 1.8–8.6%) and post-operative morbidity (27.8%, 16.4–53.4%), in-hospital mortality (0.7%, 0.3–42.0%), and average length of stay (7.0 days, 4.9–10.3 days). While no association was noted with in-hospital mortality, higher laparoscopy rates were correlated with lower post-operative morbidity (correlation coefficient [r]=−0.12, p=0.04) and shorter hospital stays (r=−0.23, p<0.001), but higher intra-operative morbidity (r=0.19, p<0.001) rates. This was not observed among hospitals with high procedure volumes. Conclusions Higher laparoscopy rates were associated with only slightly lower post-operative morbidity rates and modestly shorter hospitalizations.

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“…14–16 This difference may be related to several factors. First, the identification of laparoscopy cases has changed since these prior studies were conducted.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital-Level Outcomes Associated with Laparoscopic Colectomy for Cancer in the Minimally Invasive Era

Fox

Desai

Krumholz

et al. 2012

Journal of Gastrointestinal Surgery

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“…This dramatic decline in the incidence of colorectal cancer has been largely attributed to the increase adoption of fecal-occult-blood test (FOBT) and colonoscopy screening, which allows early detection and removal of adenomatous polyps 3–5 . The decrease in colorectal cancer mortality is likely due to a combined effects of several factors such as increase in adoption of colorectal cancer screening 6, 7 , changes in risk factors for colorectal cancer 5, 8, 9 , and improvement in colorectal cancer treatment 5, 10–12 .…”

Section: Introductionmentioning

confidence: 99%

Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Lee

Chiu

Wang

et al. 2017

Sci Rep

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Limited data are available for the epidemiology and outcome of colorectal cancer in relation to the three main surgical treatment modalities (open, laparoscopic and robotic). Using the US National Inpatient Sample database from 2004 to 2012, we identified 1,265,684 hospitalized colorectal cancer patients. Over the 9 year period, there was a 13.5% decrease in the number of hospital admissions and a 43.5% decrease in in-hospital mortality. Comparing the trend of surgical modalities, there was a 35.4% decrease in open surgeries, a 3.5 fold increase in laparoscopic surgeries, and a 41.3 fold increase in robotic surgeries. Nonetheless, in 2012, open surgery still remained the preferred surgical treatment modality (65.4%), followed by laparoscopic (31.2%) and robotic surgeries (3.4%). Laparoscopic and robotic surgeries were associated with lower in-hospital mortality, fewer complications, and shorter length of stays, which might be explained by the elective nature of surgery and earlier tumor grades. After excluding patients with advanced tumor grades, laparoscopic surgery was still associated with better outcomes and lower costs than open surgery. On the contrary, robotic surgery was associated with the highest costs, without substantial outcome benefits over laparoscopic surgery. More studies are required to clarify the cost-effectiveness of robotic surgery.

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“…Clinical trials and recent reports have found a reduction in mortality and morbidity compared to open surgery [3][4][5][6][7][8][9][10], leading to the general adoption of the laparoscopic approach to colonic diseases.…”

mentioning

confidence: 99%

Are there differences between right and left colectomies when performed by laparoscopy?

et al. 2015

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Dramatic Decreases in Mortality From Laparoscopic Colon Resections Based on Data From the Nationwide Inpatient Sample

Cited by 56 publications

References 34 publications

Hospital-Level Outcomes Associated with Laparoscopic Colectomy for Cancer in the Minimally Invasive Era

Hospital-Level Outcomes Associated with Laparoscopic Colectomy for Cancer in the Minimally Invasive Era

Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Are there differences between right and left colectomies when performed by laparoscopy?

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