The prevalence of laparoscopy and patient safety outcomes: an analysis of colorectal resections

Abstract

Background: Although laparoscopic colorectal surgery is associated with faster postoperative recovery and shorter hospital stays than open surgery, perioperative patient safety analyses using process-focused, validated measures have yet to be performed.

Methods: This study analyzed the U.S. Nationwide Inpatient Sample, a 20 % weighted sample of inpatient hospital discharges, from 1998 to 2009. The study included patients who underwent open or laparoscopic colorectal resections and excluded those younger than 18 years and those who underwent emergent or multiple colorectal operations. The primary outcome measure was surgery-specific patient safety indicators (PSIs). Uni- and multivariate regression methods were used to estimate associations of surgery type with PSIs.

Results: A total of 2,936,641 patients were identified, and 177,547 (6 %) of these patients underwent laparoscopic colorectal resections. The laparoscopic patients were younger (p < 0.001) and more likely to be Caucasian (p = 0.005) and male (p < 0.001), to have lower Charlson scores (p < 0.001), and to undergo surgery in teaching hospitals (p < 0.001) located in urban areas (p < 0.001). The prevalence of laparoscopic surgery has increased rapidly in recent years, from 5 to 29 % of all colorectal procedures performed in 2007 and 2009, respectively. The prevalence of any PSI was lower in the laparoscopic group (4.2 vs. 8.3 %; p < 0.001). Multivariate analyses showed that the likelihood of any PSI for laparoscopic colorectal resection was 57 % lower than for open resections (odds ratio, 0.43; 95 % confidence interval, 0.40-0.46; p < 0.001).

Conclusion: Laparoscopic colorectal surgery was associated with a lower risk of adverse patient safety events, a difference that became more pronounced as the prevalence of laparoscopy increased. Future studies should focus on factors that promote the safe adoption of innovative surgical techniques and optimize surgical outcomes.