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

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.

Figure 1

Growth of colorectal operations in hospitals with different adoption rates of laparoscopy. Hospitals that had been in SCOAP since 2006 were categorized into tertiles of low (n=4), middle (n=6), high use (n=3) of laparoscopy using individual hospital’s aggregate data from 2006 to 2010. Using hospitals with data from 2006 to 2010, average numbers of elective colorectal operations per hospital per year are graphed for each calendar year for (A) Overall and (B) grouped by right hemicolectomies (non-cancer indications) and diverticular disease.

Figure 1

Growth of colorectal operations in hospitals with different adoption rates of laparoscopy. Hospitals that had been in SCOAP since 2006 were categorized into tertiles of low (n=4), middle (n=6), high use (n=3) of laparoscopy using individual hospital’s aggregate data from 2006 to 2010. Using hospitals with data from 2006 to 2010, average numbers of elective colorectal operations per hospital per year are graphed for each calendar year for (A) Overall and (B) grouped by right hemicolectomies (non-cancer indications) and diverticular disease.