Laparoscopic Right Hemicolectomy Should Be the Standard of Care for Diseases of the Right Colon Which Require Surgical Resection: A Large Multicenter Outcome Study

Oleg Dolghi, MD, Vishal M Kothari, MD, Jason F Reynoso, MD, Elizabeth M Schmidt, MD, Anton Simorov, MD, J U Unnirevi, MBBS, Dmitry Oleynikov, MD. University of Nebraska Medical Center

Introduction: A large multi-center study on outcomes of laparoscopic and open right hemicolectomy has not been performed. The objective of this study was to retrospectively examine and compare perioperative outcomes of laparoscopic (LRH) and open (ORH) right hemicolectomy, including cost and risk.

Methods: Discharge data from the University HealthSystem Consortium (UHC) database was accessed using International Classification of Disease (ICD-9) codes during a 21 month period between October 2008 and July 2010. UHC is an alliance of more than 100 academic medical centers and nearly 200 affiliate hospitals. UHC’s Clinical Data Base / Resource Manager (CDB/RM) allows member hospitals to compare patient-level risk-adjusted outcomes for performance improvement purposes. Discharge data on unselected patients with benign and malignant diseases requiring right hemicolectomy was collected. Main outcome measures analyzed were mortality, morbidity, 30-day readmission, intensive care unit (ICU) admission, overall length of hospital stay (LOS) and costs.

Results: A total of 18,263 patients with benign and malignant diseases of the right colon underwent LRH (n=5,800) or ORH (n=12,463) between October 2008 and July 2010. Overall patients undergoing LHR demonstrated superior outcomes including lower mortality, morbidity, ICU admission rate, length of stay, 30-day readmission rate and cost. When patients with minor/moderate severity of illness are compared, those who underwent LRH showed significantly lower mortality (0.06% LRH vs. 0.18% ORH; p<0.0001), lower overall morbidity (22.90% LRH vs. 46.97% ORH; p<0.0001) and lower ICU admission rate (14.51% LRH vs. 20.95% ORH; p< 0.0001). Length of stay (4.97 ± 2.51 days LRH vs. 7.16 ± 6.12 days ORH; p<0.0001), 30-day readmission rate (3.99% LRH vs. 6.42% ORH; p<0.0001) and hospital costs ($15,208 ± 6,919 LRH vs. $18,861 ± 10,699 ORH; p<0.0001) were substantially higher with open right hemicolectomy group. Comparison of patients with major/extreme severity of illness also demonstrated significantly improved perioperative outcomes in the LRH group.

Conclusions: This retrospective, multi-center analysis demonstrated that patients undergoing laparoscopic right hemicolectomy have overall superior perioperative outcomes when compared to patients undergoing open right hemicolectomy. When patients are risk-adjusted into both minor/moderate and major/extreme severity of illness groups and compared accordingly LRH showed significantly better outcomes than ORH in both lower and higher risk patients. The laparoscopic right hemicolectomy has significant advantages over open right hemicolectomy and can be regarded as the standard of care in patients eligible for the technique.

Session: SS05
Program Number: S023

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