Laparoscopic Colon Resection Trends in Utilization and Rate of Conversion to Open Procedure
| Autor: | Valerie Shostrom, Eugene Boilesen, Anton Simorov, Jon S. Thompson, Dmitry Oleynikov, Abhijit Shaligram |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Databases Factual medicine.medical_treatment MEDLINE Colon resection Colonic Diseases Young Adult Postoperative Complications Health care medicine Retrospective analysis Humans Laparoscopy Colectomy Aged Retrospective Studies Academic Medical Centers medicine.diagnostic_test business.industry General surgery Retrospective cohort study Middle Aged United States Surgery Logistic Models Outcome and Process Assessment Health Care Multivariate Analysis Female Risk Adjustment National database business |
| Zdroj: | Annals of Surgery. 256:462-468 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0b013e3182657ec5 |
| Popis: | This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR).This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals.A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium- to large-sized hospitals (47.0%-49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95% CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay.There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period. |
| Databáze: | OpenAIRE |
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