The Effect of Laparoscopy on the Risk Readmission After Colorectal Surgery

Miriam Tsao, MD1, Aristithes Doumouras, MD1, Fady Saleh, MD, MPH2, Dennis Hong, MD, MSc1. 1McMaster University, 2William Osler Healthcare

INTRODUCTION: This study evaluated whether laparoscopy was an independent predictor of 30-day readmission after elective surgical resection for colorectal cancer (CRC) in Ontario, Canada. Avoidable readmission after surgery is a major burden and is common after CRC surgery. This is particularly relevant in the oncologic population as it results in potential delays to adjuvant therapy. Although laparoscopic CRC surgery has been gaining popularity its effect on readmission rates has not been well established.

 

METHODS: We performed a population-based cohort study that included all patients who received an elective colorectal resection for CRC in Ontario, Canada from April 2008 until March 2012. Patient comorbidities, procedures and demographics were derived from the Canadian Institute for Health Information Discharge Abstract Database. Socioeconomic status was derived from the Ontario Marginalization Index. Thirty-day readmission rates were calculated from index procedure. Multivariable logistic regression was used to examine independent predictors of readmission and included relevant clinical and demographic covariates.  A sensitivity analysis was conducted based on operative time.

RESULTS: Over 4 years, 13,966 procedures were performed with 5,212 (37%) performed laparoscopically. The 30-day readmission rate was 8.6%, which is similar to other major population-based cohorts. After multivariate regression, patients who underwent a laparoscopic procedure were 0.80 times as likely to be readmitted when compared with an open procedure (95% CI 0.70 – 0.91, p<0.01) (Table 1). This effect remained after a sensitivity analysis for case complexity that eliminated the longest 25% of open cases OR 0.87 (95% CI 0.75 – 1.00, p=0.046). Significant predictors of readmission are detailed in Table 1.

CONCLUSION: Laparoscopy is a significant factor in minimizing readmission rates after surgical resection for CRC and increasing its utilization should be considered important to any program trying to decrease readmission rates. 

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