National Utilization of Minimally Invasive Surgery for Colon Resection: An Analysis of Recent Trends

Allyson H Stone, MD MS, Stefan Holubar, MD MPH, Samuel Finlayson, MD MPH. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

 

INTRODUCTION.
A relatively slow rate of rise in the proportion of elective colon resections performed laparoscopically prior to 2005 was shown in a prior study of national inpatient data. Since 2004, several published studies showed significant benefits of laparoscopic colectomy, and the COST trial demonstrated that laparoscopic colectomy is oncologically sound, but to what degree these studies have accelerated the adoption of laparoscopic colectomy nationally is unknown. The objective of the present study was to examine recent nationwide trends in the adoption of laparoscopy for elective colon resections since 2004.

METHODS.
Using the Nationwide Inpatient Sample, which includes national data for a 20% sample of non-federal hospitals across the United States, we retrospectively identified all laparoscopic colon resection procedures performed on adults between January 1, 2005 and December 31, 2009. We used sampling weights to estimate national procedure totals and calculated proportions performed laparoscopically, stratified by procedure type, indication, hospital characteristics, and geographic region. Pearson chi square tests were used to assess the statistical significance of trends observed over time.

RESULTS.
From 2005 to 2009, the proportion of colectomy procedures performed laparoscopically increased 5.6 times, from 8.2% to 40.1%. The rise in use of laparoscopy was greatest for right hemicolectomy procedures (8.6% to 48.0%).  Abdominoperineal resection of the rectum (APR) remained the procedure least likely to be performed laparoscopically (2.11% to 3.38%).  By indication, the greatest increase was observed for colon cancer (5.9 times, from 5.75% to 34%), and smallest increase was observed for inflammatory bowel disease (3.5 times, from 5.7% to 19.8%). All trends over time were statistically significant (p<0.0001). The proportion of procedures performed laparoscopically was highest in the Northeast region (44% in 2009) and in urban hospitals (42% in 2009).  While in earlier years urban teaching hospitals performed a higher proportion of colectomies laparoscopically, by 2009 rates were similar at urban teaching vs. non-teaching hospitals (41.7% vs 41.5%).

CONCLUSION
There has been a significant rise in use of laparoscopy for colon resections since 2005. This rise has been most dramatic for cancer patients. Possible explanations for this trend towards more widespread acceptance of laparoscopy as a viable alternative to open colon resection include the impact of clinical studies such as the COST trial, dissemination of technical skills, and increased patient awareness and demand for minimally invasive procedures.


Session Number: Poster – Poster Presentations
Program Number: P093
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