Skip to main content

Advertisement

SpringerLink
Log in

Patient Acuity and Operative Technique Associated with Post-Colectomy Mortality Across New York State: an Analysis of 160,792 Patients over 20 years

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

This study sought to characterize in-hospital post-colectomy mortality in New York State. One hundred sixty thousand seven hundred ninety-two patients who underwent colectomy from 1995 to 2014 were analyzed from the all-payer New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear trends of in-hospital mortality rate over 20 years were calculated using log-linear regression models. Chi-square tests were used to compare categorical variables between patients. Multivariable regression models were further used to calculate risk of in-hospital mortality associated with specific demographics, co-morbidities, and perioperative complications. From 1995 to 2014, 7308 (4.5%) in-hospital mortalities occurred within 30 days of surgery. Over this time period, the rate of overall in-hospital post-colectomy mortality decreased by 3.3% (6.3 to 3%, p < 0.0001). The risk of in-hospital mortality for patients receiving emergent and elective surgery decreased by 1% (RR 0.99 [0.98–1.00], p = 0.0005) and 5% (RR 0.95 [0.94–0.96], p < 0.0001) each year, respectively. Patients who underwent open surgeries were more likely to experience in-hospital mortality (adjusted OR 3.65 [3.16–4.21], p < 0.0001), with an increased risk of in-hospital mortality each year (RR 1.01 [1.00–1.03], p = 0.0387). Numerous other risk factors were identified. In-hospital post-colectomy mortality decreased at a slower rate in emergent versus elective surgeries. The risk of in-hospital mortality has increased in open colectomies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bonnor RM, Ludwig KA. Laparoscopic colectomy for colon cancer: comparable to conventional oncologic surgery? Clin Colon Rectal Surg. 2005 18(3):174–181.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H. The clinical outcomes of surgical therapy study group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007 246(4):655–662.

    Article  PubMed  Google Scholar 

  3. Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 Summary. Vital Health Stat. 2010 29:1–21.

    Google Scholar 

  4. Cirocchi R, Farinella E, Trastulli S, Sciannameo F, Audisio RA. Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review. Colorectal Dis. 2012 14(6):671–83.

    Article  CAS  PubMed  Google Scholar 

  5. Peyrin-Biroulet L, Germain A, Patel AS, Lindsay JO. Systematic review: outcomes and post-operative complications following colectomy for ulcerative colitis. Aliment Pharmacol Ther. 2016 44(8):807–16.

    Article  CAS  PubMed  Google Scholar 

  6. Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL. Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc. 2016.

  7. Casillas MA Jr, Leichtle SW, Wahl WL, Lampman RM, Welch KB, Wellock T, Madden EB, Cleary RK. Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations. Am J Surg. 2014 208(1):33–40.

    Article  PubMed  Google Scholar 

  8. The Clinical Outcomes of Surgical Therapy Study Group. Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350(20): 2050–2059.

    Article  Google Scholar 

  9. Lacy AM, Garcia-Valdecasas JC, Delgado S. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 2002; 359(9325): 2224–2229.

    Article  PubMed  Google Scholar 

  10. Bagshaw PF, Allardyce RA, Frampton CM. Long-term outcomes of the Australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 2012 256(6): 915–919.

    Article  PubMed  Google Scholar 

  11. COLOR Study Group. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 2000 17(6): 617–622.

    Google Scholar 

  12. Papageorge CM, Kennedy GD, Carchman EH.J National trends in short-term outcomes following non-emergent surgery for diverticular disease. Gastrointest Surg. 2016 20(7):1376–87.

  13. Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer. 2012 3:49–57.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008 Apr 16(2):1–37.

    Google Scholar 

  15. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop W C, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer H J. Survival after laparoscopic surgery versus open surgery for colon cancer:long-term outcome of a randomised clinical trial. Lancet Oncol. 2009 10(1):44–52.

    Article  PubMed  Google Scholar 

  16. Moghadamyeghaneh Z, Hanna MH, Hwang G, Mills S, Pigazzi A, Stamos MJ, Carmichael JC. Outcomes of colon resection in patients with metastatic colon cancer. Am J Surg. 2016 212(2):264–71.

    Article  PubMed  Google Scholar 

  17. Kream J, Ludwig KA, Ridolfi TJ, Peterson CY. Achieving low anastomotic leak rates utilizing clinical perfusion assessment. Surgery. 2016 160(4):960–7.

    Article  PubMed  Google Scholar 

  18. Yeo HL, Isaacs AJ, Abelson JS, Milsom JW, Sedrakyan A. Comparison of open, laparoscopic, and robotic colectomies using a large national database: outcomes and trends related to surgery center volume. Dis Colon rectum. 2016 59(6):535–42.

  19. Miller PE, Dao H, Paluvoi N, Bailey M, Margolin D, Shah N, Vargas HD. Comparison of 30-day postoperative outcomes after laparoscopic vs robotic colectomy. J Am Coll Surg. 2016 223(2):369–73.

    Article  PubMed  Google Scholar 

  20. Kim CW, Kim CH, Baik SH. Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg. 2014 18(4):816–30.

    Article  PubMed  Google Scholar 

  21. Malangoni MA, Biester TW, Jones AT, Klingensmith ME, Lewis Jr FR. Operative experience of surgery residents: trends and challenges. J Surg Educ. 2013 70(6):783–8.

    Article  PubMed  Google Scholar 

  22. Ravi P, Sood A, Schmid M, Abdollah F, Sammon JD, Sun M, Klett DE, Varda B, Peabody JO, Menon M, Kibel AS, Nguyen PL, Trinh, Q. Racial/ethnic disparities in perioperative outcomes of major procedures: results from the National Surgical Quality Improvement Program. Annals of Surgery. 2015 262(6): 955–964.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the support from the Biostatistical Consulting Core at the School of Medicine, Stony Brook University.

Author information

Authors and Affiliations

  1. Stony Brook University School of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Ryan Lamm & Steven N. Mathews

  2. Department of Family, Population and Preventative Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Jihye Park

  4. Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA

    Mark Talamini & Aurora D. Pryor

  5. Section of General Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA

    Dana Telem

Authors
  1. Ryan Lamm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven N. Mathews
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jie Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jihye Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Talamini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aurora D. Pryor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dana Telem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan Lamm.

Additional information

Meeting Presentation: American College of Clinical Surgeons (ACS) Clinical Congress, Washington, D.C. October 2016.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lamm, R., Mathews, S.N., Yang, J. et al. Patient Acuity and Operative Technique Associated with Post-Colectomy Mortality Across New York State: an Analysis of 160,792 Patients over 20 years. J Gastrointest Surg 21, 879–884 (2017). https://doi.org/10.1007/s11605-017-3393-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-017-3393-2

Keywords

Search

Navigation