Hospital Colectomy Volume As a Surrogate for Advanced Laparoscopy

Although laparoscopic colectomy has been reported to have favorable outcomes compared to open colectomy, it has yet to gain widespread acceptance in the United States. We sought to investigate whether hospital volume for colectomy was an important factor to predict the likelihood of having colectomy performed laparoscopically.
Methods: Using the Nationwide Inpatient Sample (NIS) from 1998 – 2006, patients undergoing elective colon resection with and without use of laparoscopy were identified. Unique hospital identifiers were used to divide hospital volume into thirds based on number of colectomies performed per year (lowest third (LV) < 50/year; 50 = 105/year). Primary endpoint was the use of laparoscopy after adjusting for patient and hospital covariates.
Results: A total of 209,769 colon resections were performed from 1998 – 2006. Overall, only 8,407 (4.0%) of these were performed with laparoscopy. Both the number of colectomies and those performed with laparoscopy increased over time. HV hospitals used laparoscopy more (5.2% vs. 3.8% vs. 3.0%). HV hospitals tended to be large (83.1%), urban (99.1%), teaching (69.0%) hospitals that treated more patients in the highest income bracket and with private insurance when compared to either MV or LV centers. A mortality benefit overall was observed at HV centers compared to LV hospitals (OR 0.6; 95% CI 0.6-0.7) and MV hospitals (OR 0.8; 95% CI 0.7-0.9). After adjusting for covariates, patients with private insurance (OR 1.2; 95% CI 1.1-1.3) and high income (OR 1.2; 95% CI 1.2-1.3) were more likely to independently undergo laparoscopy. In addition, HV hospitals were more likely to use laparoscopy than LV hospitals (OR 1.3; 95% CI 1.2-1.4) and MV hospitals (OR 1.1; 95% CI 1.1-1.2).
Conclusions: Socioeconomic differences appear to exist at HV hospitals compared to MV/LV hospitals for colectomy. Laparoscopy is still only used in small percentage of colon resections. Using colectomy as a model, annual hospital volume appears to be an important surrogate for the advancement of laparoscopy and future technology.

Session: Podium Presentation

Program Number: S045

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