Can Laparoscopy for Colon Resection Reduce the Need for Discharge to Skilled Care Facility?

Abhijit S Shaligram, MD, Lynette Smith, MS, Pradeep Pallati, MD, Anton Simorov, MD, Jane Meza, PhD, Dmitry Oleynikov, MD, FACS

Nebraska Medical Center, University of Nebraska, Omaha

OBJECTIVE:
A significant proportion of patients, especially the elderly undergoing colon resections are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open vs. laparoscopy contributed to their discharge to the skilled care facility.

METHOD:
This was a retrospective analysis using discharge data from Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to non-routine discharge defined as transfer to short term hospital, skilled nursing facility, intermediate care, home health and another type of facility.

RESULTS:
A weighted total of 221,294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70,361 (32%) were performed laparoscopic and 150,933 (68%) by open technique. 139,047 (62.8%) patients had routine discharge and 73,572(33.3%) non-routine. 8,445 (3.8%) patients died while in the hospital, and 229 (0.1%) left against medical advice and were excluded from further analysis. On univariate analysis, age > 65 years, female gender, open technique (compared to laparoscopic), Medicare/Medicaid insurance status, co-morbidity index of one or more, and diagnosis (like hemorrhage, malignancy or inflammatory bowel disease) predicted non-routine discharge. A multivariate logistic model was then used to predict non-routine discharge in these patients using variables significant in the univariate analysis at the alpha=0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio, 2.85; 95% CI, 2.59 -3.14).

CONCLUSIONS:
In addition to the expected factors like advancing age, female gender and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with the increased risk of discharge to skilled care facilities. When feasible, laparoscopic technique should be considered as an option especially in the elderly patients who require colon resection as it may reduce their risk of discharge to skilled care facility.

Session: Podium Presentation

Program Number: S089