Laparoscopic colorectal surgery: a better look into the latest trends

Abstract

Background: The latest trends of laparoscopic colorectal surgery (LCRS) after the introduction of International Classification of Diseases, Ninth Revision laparoscopic procedure codes in 2008 remains unknown. This study evaluates LCRS trends before and after the application of specific codes for LCRS.

Design: Retrospective analysis of elective surgery for colon cancer, rectal cancer, and diverticulitis using Nationwide Inpatient Sample data from 2007 and 2009.

Main outcome measure: Primary outcome measures included in-hospital mortality, length of stay, and total charge.

Results: A total of 126 921 patients in 2007 and 117 177 patients in 2009 underwent colorectal surgery. Laparoscopic colorectal surgery increased dramatically from 13.8% in 2007 to 42.6% in 2009 (P.01). This trendwas disease and procedure specific. When compared with 2007, patients who underwent LCRS in 2009 had lower conversion rates (14.8% vs 32.1%, P.001). In 2009, LCRS had lower in-hospital mortality (0.5% vs 1.1%, P.001) and a shorter length of hospital stay (5 vs 6 days, P.001) compared with open surgery. In 2009, when compared with successful LCRS, conversion to open surgery was associated with a longer length of hospital stay (6 vs 5 days, P.01), increased hospital charges, and increased mortality (0.7% vs 0.5%, P.01).

Conclusion: The marked increase in LCRS when comparing these 2 years is unlikely only due to the changing practice of colorectal surgery but brings into question the accuracy of data prior to 2009. Our report of Nationwide Inpatient Sample 2009 data represents the most accurate reflection of the use of LCRS in the United States. These data can serve as a benchmark for future comparative studies.