TY - JOUR
T1 - Adoption of laparoscopy for elective colorectal resection
T2 - A report from the surgical care and outcomes assessment program
AU - Kwon, Steve
AU - Billingham, Richard
AU - Farrokhi, Ellen
AU - Florence, Michael
AU - Herzig, Daniel
AU - Horvath, Karen
AU - Rogers, Terry
AU - Steele, Scott
AU - Symons, Rebecca
AU - Thirlby, Richard
AU - Whiteford, Mark
AU - Flum, David R.
N1 - Funding Information:
The Surgical Care and Outcomes Assessment Program is a program of the Foundation for Healthcare Quality. The Surgical Care and Outcomes Assessment Program is supported by a grant from Washington State’s Life Science Discovery Fund and Agency for Healthcare Research and Quality Grant Number 1 R01 HS 20025-01 .
PY - 2012/6
Y1 - 2012/6
N2 - Background: The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. Study Design: The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4th quarter of 2005 through 4th quarter of 2010. Results: Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 ± 15.6 years; 55.2% women), 38.0% were performed laparoscopically (17.8% laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3% in 4th quarter of 2005 to 41.6% in 4th quarter of 2010 (trend during study period, p < 0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95% CI, 0.39-0.7), wound infections (OR = 0.45; 95% CI, 0.34-0.61), and composite of adverse events (OR = 0.58; 95% CI, 0.43-0.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4% increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology. Conclusions: The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.
AB - Background: The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. Study Design: The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4th quarter of 2005 through 4th quarter of 2010. Results: Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 ± 15.6 years; 55.2% women), 38.0% were performed laparoscopically (17.8% laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3% in 4th quarter of 2005 to 41.6% in 4th quarter of 2010 (trend during study period, p < 0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95% CI, 0.39-0.7), wound infections (OR = 0.45; 95% CI, 0.34-0.61), and composite of adverse events (OR = 0.58; 95% CI, 0.43-0.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4% increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology. Conclusions: The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.
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U2 - 10.1016/j.jamcollsurg.2012.03.010
DO - 10.1016/j.jamcollsurg.2012.03.010
M3 - Article
C2 - 22533998
AN - SCOPUS:84861573375
SN - 1072-7515
VL - 214
SP - 909-918.e1
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -