Skip to main content

Advertisement

SpringerLink
Log in

The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

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

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3):CD003145. doi:10.1002/14651858.CD003145.pub2

  3. Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  4. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72

    PubMed  PubMed Central  Google Scholar 

  5. Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303

    Article  PubMed  Google Scholar 

  6. Champagne BJ, Delaney CP (2007) Laparoscopic approaches to rectal cancer. Clin Colon Rectal Surg 20:237–248

    Article  PubMed  PubMed Central  Google Scholar 

  7. Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L (2010) Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 24:653–661

    Article  PubMed  Google Scholar 

  8. Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824

    Article  PubMed  Google Scholar 

  9. Young-Fadok TM, HallLong K, McConnell EJ (2001) Gomez Rey G, Cabanela RL. Advantages of laparoscopic resection for ileocolic Crohn’s disease. Improved outcomes and reduced costs. Surg Endosc 15:450–454

    Article  CAS  PubMed  Google Scholar 

  10. Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388

    Article  CAS  PubMed  Google Scholar 

  11. Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 50:908–919

    Article  PubMed  Google Scholar 

  12. Aly OE, Quayyum Z (2012) Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis 27:855–860

    Article  CAS  PubMed  Google Scholar 

  13. Keller DS, Champagne BJ, Reynolds HLJ, Stein SL, Delaney CP (2014) Cost-effectiveness of laparoscopy in rectal cancer. Dis Colon Rectum 57:564–569

    Article  PubMed  Google Scholar 

  14. Fox J, Gross CP, Longo W, Reddy V (2012) Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. Dis Colon Rectum 55:501–508

    Article  PubMed  Google Scholar 

  15. Kwon S, Billingham R, Farrokhi E et al (2012) Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg 214(909–18):e1

    PubMed  Google Scholar 

  16. Ballian N, Weisensel N, Rajamanickam V et al (2012) Comparable postoperative morbidity and mortality after laparoscopic and open emergent restorative colectomy: outcomes from the ACS NSQIP. World J Surg 36:2488–2496

    Article  PubMed  Google Scholar 

  17. Catani M, De Milito R, Romagnoli F, Romeo V, Modini C (2011) Laparoscopic colorectal surgery in urgent and emergent settings. Surg Laparosc Endosc Percutan Tech 21:340–343

    Article  PubMed  Google Scholar 

  18. Champagne B, Stulberg JJ, Fan Z, Delaney CP (2009) The feasibility of laparoscopic colectomy in urgent and emergent settings. Surg Endosc 23:1791–1796

    Article  PubMed  Google Scholar 

  19. Chand M, Siddiqui MR, Gupta A et al (2014) Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease. World J Gastroenterol 20(45):16956–16963

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nash GM, Bleier J, Milsom JW, Trencheva K, Sonoda T, Lee SW (2010) Minimally invasive surgery is safe and effective for urgent and emergent colectomy. Colorectal Dis 12:480–484

    Article  CAS  PubMed  Google Scholar 

  21. Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A (2013) Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg 37:2458–2467

    Article  PubMed  Google Scholar 

  22. Stulberg JJ, Champagne BJ, Fan Z et al (2009) Emergency laparoscopic colectomy: does it measure up to open? Am J Surg 197:296–301

    Article  PubMed  PubMed Central  Google Scholar 

  23. All Patient Refined Diagnostic Related Groups Methodology Overview. v20.0. 3M Health Information Systems. http://www.hcup-us.ahrq.gov/db/nation/nis/APR-DRGsV20MethodologyOverviewandBibliography.pdf. Last accessed June 2015

  24. Ingraham AM, Cohen ME, Bilimoria KY et al (2010) Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. Surgery 148:217–238

    Article  PubMed  Google Scholar 

  25. Al-Homoud S, Purkayastha S, Aziz O et al (2004) Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models. Surg Oncol 13:83–92

    Article  PubMed  Google Scholar 

  26. Constantinides VA, Tekkis PP, Senapati A (2006) Comparison of POSSUM scoring systems and the surgical risk scale in patients undergoing surgery for complicated diverticular disease. Dis Colon Rectum 49:1322–1331

    Article  PubMed  Google Scholar 

  27. Law WL, Lam CM, Lee YM (2006) Evaluation of outcome of laparoscopic colorectal resection with POSSUM, Portsmouth POSSUM and colorectal POSSUM. Br J Surg 93:94–99

    Article  CAS  PubMed  Google Scholar 

  28. Senagore AJ, Warmuth AJ, Delaney CP, Tekkis PP, Fazio VW (2004) POSSUM, p-POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum 47:1435–1441

    Article  PubMed  Google Scholar 

  29. Tekkis PP, Prytherch DR, Kocher HM et al (2004) Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 91:1174–1182

    Article  CAS  PubMed  Google Scholar 

  30. Ballian N, Rajamanickam V, Harms BA et al (2013) Predictors of mortality after emergent surgery for acute colonic diverticulitis: analysis of National Surgical Quality Improvement Project data. J Trauma Acute Care Surg 74:611–616

    Article  PubMed  Google Scholar 

  31. ACS Surgical Risk Calculator. http://riskcalculator.facs.org. Last accessed Feb 2013

Download references

Acknowledgments

The authors acknowledge Michael Rambo Ph.D. for assistance with statistical analysis.

Author information

Authors and Affiliations

  1. Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA

    Deborah S. Keller, Juan Ramon Flores-Gonzalez, Jean Paul LeFave, Ali Mahmood & Eric M. Haas

  2. Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA

    Rodrigo Pedraza

  3. Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA

    Jean Paul LeFave, Ali Mahmood & Eric M. Haas

  4. Houston Methodist Hospital, Houston, TX, USA

    Ali Mahmood & Eric M. Haas

Authors
  1. Deborah S. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodrigo Pedraza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Ramon Flores-Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Paul LeFave
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Mahmood
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric M. Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah S. Keller.

Ethics declarations

Disclosures

Drs. Keller, Flores, LeFave, Pedraza, Mahmood, and Haas have no relevant disclosures or relationships related to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keller, D.S., Pedraza, R., Flores-Gonzalez, J.R. et al. The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes. Surg Endosc 30, 3321–3326 (2016). https://doi.org/10.1007/s00464-015-4605-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4605-z

Keywords

Search

Navigation