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J Am Coll Surg. 2012 Jun;214(6):909-18.e1. doi: 10.1016/j.jamcollsurg.2012.03.010. Epub 2012 Apr 24.

Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program.

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1
Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.

Abstract

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.

PMID:
22533998
PMCID:
PMC3397823
DOI:
10.1016/j.jamcollsurg.2012.03.010
[Indexed for MEDLINE]
Free PMC Article
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