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

Abstract

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.

A propensity score-matching analysis comparing the oncological outcomes of laparoscopic and open surgery in patients with Stage I/II colon and upper rectal cancers

“…Regardless, the mean length of the operation in the LAC group was 233 min, which falls within the regular range for LAC surgery. Previous studies demonstrated that the incidence of postoperative complications associated with LAC is comparable to that encountered during OC [4,23], when it is performed by surgeons trained in minimally invasive techniques [24,25]. We also confirmed that LAC is not associated with a significant increase in overall complications.…”

Provider Experience and the Comparative Safety of Laparoscopic and Open Colectomy

“…There are also several well-known studies suggesting a correlation between higher surgeon volumes and better outcomes for laparoscopic colectomy (Birkmeyer et al 2002;Fox et al 2012). When looking at individual surgeons' volume, studies vary in their estimation of the "learning curve" for proficiency in laparoscopy from 10 to 50 colectomies (Tekkis et al 2005;Maeda et al 2010;Waters et al 2010).…”

Regional versus metropolitan pancreaticoduodenectomy mortality in Australia

“…A national USA study confirmed a significant geographical variation in mortality for patients undergoing surgical management of diverticulitis despite adjustment for demographic and socio‐economic factors . Furthermore, two USA studies investigating colonic resection for malignancy determined significant variation in risk standardized in‐hospital mortality rates across the nation . Analysis demonstrated five hospital networks to have significantly higher risk adjusted 30‐day post‐operative mortality compared with others across England .…”