Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: A national database review of academic medical centers

Anton Simorov, Abhijit Shaligram, Valerie Shostrom, Eugene Boilesen, Jon S Thompson, Dmitry Oleynikov

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective: This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR). Methods: This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals. Results: A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium-to large-sized hospitals (47.0%-49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95% CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay. Conclusions: There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.

Original languageEnglish (US)
Pages (from-to)462-468
Number of pages7
JournalAnnals of surgery
Volume256
Issue number3
DOIs
StatePublished - Sep 1 2012

Fingerprint

Conversion to Open Surgery
Colon
Databases
Odds Ratio
Confidence Intervals
Colectomy
Length of Stay
Mid-Atlantic Region
Perioperative Period
Sex Ratio
Sigmoid Colon
Logistic Models
Morbidity
Mortality

Keywords

  • colon
  • conversion
  • laparoscopy
  • outcomes
  • resection
  • trends

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic colon resection trends in utilization and rate of conversion to open procedure : A national database review of academic medical centers. / Simorov, Anton; Shaligram, Abhijit; Shostrom, Valerie; Boilesen, Eugene; Thompson, Jon S; Oleynikov, Dmitry.

In: Annals of surgery, Vol. 256, No. 3, 01.09.2012, p. 462-468.

Research output: Contribution to journalArticle

Simorov, Anton ; Shaligram, Abhijit ; Shostrom, Valerie ; Boilesen, Eugene ; Thompson, Jon S ; Oleynikov, Dmitry. / Laparoscopic colon resection trends in utilization and rate of conversion to open procedure : A national database review of academic medical centers. In: Annals of surgery. 2012 ; Vol. 256, No. 3. pp. 462-468.
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abstract = "Objective: This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR). Methods: This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals. Results: A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2{\%}), with 5751 patients (15.8{\%}) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5{\%} in 2008 to 44.1{\%} in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8{\%}), followed by left (20.7{\%}), right (15.6{\%}), and sigmoid (14.3{\%}) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5{\%}) and in medium-to large-sized hospitals (47.0{\%}-49.0{\%}).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95{\%} confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95{\%} CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95{\%}, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95{\%} CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay. Conclusions: There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.",
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AU - Oleynikov, Dmitry

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AB - Objective: This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR). Methods: This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals. Results: A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium-to large-sized hospitals (47.0%-49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95% CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay. Conclusions: There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.

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