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

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

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 USA, it is unclear if laparoscopic colectomy continues to be associated with shorter hospitalization and comparable morbidity.

Purpose

The purpose of this study is 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 were reported with ≥1 approached laparoscopically. We assessed the correlation between a hospital’s laparoscopy rate and risk-standardized outcomes (intra- and postoperative 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 postoperative 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 postoperative morbidity [correlation coefficient (r) = −0.12, p = 0.04) and shorter hospital stays (r = −0.23, p < 0.001), but higher intraoperative 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 postoperative morbidity rates and modestly shorter hospitalizations.

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References

  1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surgical laparoscopy & endoscopy 1991; 1(3):144–50.

    CAS  Google Scholar 

  2. Schlinkert RT. Laparoscopic-assisted right hemicolectomy. Diseases of the colon and rectum 1991; 34(11):1030–1.

    Article  PubMed  CAS  Google Scholar 

  3. Fusco MA, Paluzzi MW. Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colon. Report of a case. Diseases of the Colon and Rectum 1993; 36(9):858–61.

    Article  PubMed  CAS  Google Scholar 

  4. Ota DM, Nelson H, Weeks JC. Controversies regarding laparoscopic colectomy for malignant diseases. Current Opinion in General Surgery 1994; 208–13.

  5. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Digestive Surgery 2000; 17(6):617–22.

    Google Scholar 

  6. A comparison of laparoscopically assisted and open colectomy for colon cancer. The New England Journal of Medicine 2004; 350(20):2050–9.

  7. Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2007; 25(21):3061–8.

    Article  Google Scholar 

  8. Kuhry E, Schwenk W, Gaupset R, et al. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treatment Reviews 2008; 34(6):498–504.

    Article  PubMed  Google Scholar 

  9. Schwenk W, Haase O, Neudecker J, et al. Short term benefits for laparoscopic colorectal resection. Cochrane Database of Systematic Reviews (Online) 2005(3):CD003145.

    Google Scholar 

  10. Kang CY, Halabi WJ, Luo R, et al. Laparoscopic Colorectal Surgery: A Better Look Into the Latest Trends. Arch Surg 2012:archsurg.2012.358.

  11. Fox J, Gross CP, Longo W, et al. Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. Diseases of the colon and rectum 2012; 55(5):501–8.

    Article  PubMed  Google Scholar 

  12. Etzioni DA. Laparoscopy…For all? Diseases of the colon and rectum 2012; 55(5):499–500.

    Article  PubMed  Google Scholar 

  13. Sammour T, Kahokehr A, Srinivasa S, et al. Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Annals of Surgery 2011; 253(1):35–43.

    Article  PubMed  Google Scholar 

  14. Cone MM, Herzig DO, Diggs BS, et al. Dramatic decreases in mortality from laparoscopic colon resections based on data from the nationwide inpatient sample. Archives of Surgery 2011; 146(5):594–9.

    Article  PubMed  Google Scholar 

  15. Bilimoria KY, Bentrem DJ, Merkow RP, et al. Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. Journal of Gastrointestinal Surgery 2008; 12(11):2001–9.

    Article  PubMed  Google Scholar 

  16. Kemp JA, Finlayson SR. Outcomes of laparoscopic and open colectomy: a national population-based comparison. Surgical Innovation 2008; 15(4):277–83.

    Article  PubMed  Google Scholar 

  17. Rea JD, Cone MM, Diggs BS, et al. Utilization of Laparoscopic Colectomy in the United States Before and After the Clinical Outcomes of Surgical Therapy Study Group Trial. Annals of Surgery 2011; 254(2):281–8.

    Article  PubMed  Google Scholar 

  18. Robinson CN, Chen GJ, Balentine CJ, et al. (2011) Minimally invasive surgery is underutilized for colon cancer. Annals of Surgical Oncology 18(5):1412–8.

    Article  PubMed  Google Scholar 

  19. HCUP. Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2005–2008. 2009. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp Accessed March 6, 2012.

  20. Bonjer HJ, Hop WC, Nelson H, et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Archives of surgery (Chicago, Ill. : 1960) 2007; 142(3):298–303.

    Article  PubMed  Google Scholar 

  21. Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008; 134(3):680–7.

    Article  PubMed  Google Scholar 

  22. Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Medical Care 1998; 36(1):8–27.

    Article  PubMed  CAS  Google Scholar 

  23. Austin PC, Ghali WA, Tu JV. A comparison of several regression models for analysing cost of CABG surgery. Statistics in Medicine 2003; 22(17):2799–815.

    Article  PubMed  Google Scholar 

  24. Norman G, Streiner D. Part 3: Regression and Correlation. Biostatistics: The Bare Essentials. Lewiston, NY: BC Decker, Inc.; 2008:pp. 131–232.

    Google Scholar 

  25. Nelson H, Sargent D, Wieand S, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. New England Journal of Medicine 2004; 350(20):2050–9.

    Article  CAS  Google Scholar 

  26. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncology 2005; 6(7):477–84.

    Article  PubMed  Google Scholar 

  27. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365(9472):1718–26.

    Article  PubMed  Google Scholar 

  28. Goodney PP, Stukel TA, Lucas FL, et al. Hospital volume, length of stay, and readmission rates in high-risk surgery. Annals of Surgery 2003; 238(2):161–7.

    PubMed  Google Scholar 

  29. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. New England Journal of Medicine 2002; 346(15):1128–37.

    Article  PubMed  Google Scholar 

  30. Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. The New England journal of medicine 2011; 364(22):2128–37.

    Article  PubMed  CAS  Google Scholar 

  31. Hendren S, Morris AM, Zhang W, et al. Early discharge and hospital readmission after colectomy for cancer. Diseases of the Colon and Rectum 2011; 54(11):1362–7.

    Article  PubMed  Google Scholar 

  32. Hemmila MR, Birkmeyer NJ, Arbabi S, et al. Introduction to propensity scores: A case study on the comparative effectiveness of laparoscopic vs open appendectomy. Archives of Surgery 2010; 145(10):939–45.

    Article  PubMed  Google Scholar 

  33. Stukel TA, Fisher ES, Wennberg DE, et al. Analysis of observational studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA 2007; 297(3):278–85.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the contributions of Zhenqiu Lin, PhD at the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven CT, for his contributions to this studies statistical analysis.

Financial Disclosure

All authors are affiliated with the Clinical Scholars Program, which is supported by the Robert Wood Johnson Foundation. Dr. Krumholz is supported by grant U01 HL105270-02 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute.

Conflict of Interest Disclosure

Drs. Krumholz and Gross are the recipients of a research grant from Medtronic, Inc. through Yale University, Dr. Krumholz is chair of a cardiac scientific advisory board for UnitedHealth, and Dr. Gross is a member of the Scientific Advisory Committee for Fair Health, Inc.

Disclaimers

The views expressed in this article are those of the authors and do not reflect the official policy of the United States Air Force, the Department of Defense, or the U.S. Government.

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Authors and Affiliations

  1. Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale School of Medicine, 333 Cedar Street, SHM-1E-61, PO Box 208088, New Haven, CT, 06520-8088, USA

    Justin P. Fox, Mayur M. Desai, Harlan M. Krumholz & Cary P. Gross

  2. Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Mayur M. Desai

  3. Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CT, USA

    Mayur M. Desai & Harlan M. Krumholz

  4. Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA

    Harlan M. Krumholz

  5. Section of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA

    Harlan M. Krumholz

  6. Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Cary P. Gross

  7. Cancer Outcomes Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT, USA

    Cary P. Gross

Authors
  1. Justin P. Fox
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  2. Mayur M. Desai
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  3. Harlan M. Krumholz
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  4. Cary P. Gross
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Corresponding author

Correspondence to Justin P. Fox.

Appendix

Appendix

Table 3 ICD-9-CM coding to define key variables
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Fox, J.P., Desai, M.M., Krumholz, H.M. et al. Hospital-Level Outcomes Associated with Laparoscopic Colectomy for Cancer in the Minimally Invasive Era. J Gastrointest Surg 16, 2112–2119 (2012). https://doi.org/10.1007/s11605-012-2018-z

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  • DOI: https://doi.org/10.1007/s11605-012-2018-z

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