Jason A. Kemp

Several recent clinical studies have demonstrated that laparoscopic colectomy is safe, feasible, and associated with many short-term benefits compared with open colectomy. It is unknown if outcomes observed in clinical trials can be achieved on a population level. The authors used the Nationwide Inpatient Sample to identify laparoscopic and open elective colon resections performed in the United States for each year from 2000 to 2004. They assessed differences in patient characteristics using demographic information and ICD-9 codes. They then used univariate and multiple logistic regression models to analyze the association between surgical approach and in-hospital morbidity, as well as in-hospital mortality and length of hospital stay. Patients undergoing laparoscopic colectomy tended to be younger (61 years vs 66 years, P < .001) and to have fewer comorbidities (Charlson score of 0 in 58.1% vs 37.0%, P < .001). After adjusting for patient characteristics and comorbidities, laparoscopic colectomy was associated with lower in-hospital mortality (0.6% vs 1.7%, P < .001), lower overall complication rate (32.1% vs 38.2%, P < .001), and shorter median hospital stay (5 vs 7 days, P < .001) compared with open colectomy. Significant benefits were observed in wound problems (0.8% vs 1.44%, P < .001); cardiovascular (12.5% vs 15.1%, P < .001), pulmonary (6.2% vs 8.7%, P < .001), and gastrointestinal (13.7% vs 16.1%, P < .001) morbidity; and reintervention rates (1.33% vs 1.66%, P = .02). Outcome benefits of laparoscopic colectomy previously demonstrated in clinical trials are observed on a population level.

Background Over the past 5 years, several studies have demonstrated that laparoscopic colon resection is an acceptable and perhaps preferable alternative to open resection for both benign diseases and cancer. The extent to which laparoscopic colon resections are used nationally is not known. Methods The Nationwide Inpatient Sample was used to identify laparoscopic and open elective colon resections performed in the United States each year from 2000 through 2004. The trends in adoption of the laparoscopic technique for each type of colon resection and for the most common diagnoses were identified, and differences in patient and provider characteristics were examined. Results From 2000 to 2004, the proportion of colon resections performed laparoscopically increased from 3% to 6.5%. The proportion performed for cancer increased from 1.4% to 4.3%, and for benign disease from 4.6% to 8.2%. Patients treated laparoscopically tended to be younger (median age, 61 years vs 66 years; p < 0.001) and to have fewer comorbidities (Charlson score of zero for 58.1% vs 37%; p < 0.001). Laparoscopic colon resections were more widely adopted in teaching versus nonteaching hospitals (5.1% vs 3.7%; p < 0.001) and in urban versus rural hospitals (4.7% vs 2.2%; p < 0.001). Conclusion Although the proportion of colon resections performed laparoscopically increased in the first half of this decade, it has remained very low. This trend is similar across procedure types and diagnoses. It remains to be seen whether greater patient demand and more recent trials will result in wider adoption of the laparoscopic approach.