Iyare O Esemuede1, Alodia Gabre-Kidan1, Dennis L Fowler1, Ravi P Kiran2. 1. Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA. 2. Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu.
Abstract
PURPOSE: Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well characterized. The aim of this study is to compare the risk of readmission after the two procedures in a large, nationally representative sample. METHODS: Patients who underwent colorectal resection in 2011 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. LC and OC patients were compared for patient factors, complications, and readmission rates. A multivariable analysis controlling for significant factors was performed to evaluate factors associated with readmission. RESULTS: Of 30,428 patients who underwent colorectal resection, 40.2% underwent LC. Length of stay (LOS) after LC was shorter than after OC (5.7 vs. 9.7 days, p < 0.001). LC was associated with a significantly lower rate of surgical site infections (SSI), bleeding, reoperation, 30-day mortality, and complications. Risk of readmission was greater for patients undergoing proctectomy than colectomy (12.7 vs. 10.6 %, p < 0.001), but was lower after laparoscopic than open for both procedures after controlling for confounding factors. Obesity, DM, operating time ≥180 min, steroid use, and ASA class 3-5 were found to be associated with readmission. CONCLUSION: Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.
PURPOSE: Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well characterized. The aim of this study is to compare the risk of readmission after the two procedures in a large, nationally representative sample. METHODS:Patients who underwent colorectal resection in 2011 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. LC and OC patients were compared for patient factors, complications, and readmission rates. A multivariable analysis controlling for significant factors was performed to evaluate factors associated with readmission. RESULTS: Of 30,428 patients who underwent colorectal resection, 40.2% underwent LC. Length of stay (LOS) after LC was shorter than after OC (5.7 vs. 9.7 days, p < 0.001). LC was associated with a significantly lower rate of surgical site infections (SSI), bleeding, reoperation, 30-day mortality, and complications. Risk of readmission was greater for patients undergoing proctectomy than colectomy (12.7 vs. 10.6 %, p < 0.001), but was lower after laparoscopic than open for both procedures after controlling for confounding factors. Obesity, DM, operating time ≥180 min, steroid use, and ASA class 3-5 were found to be associated with readmission. CONCLUSION: Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.
Authors: Eric B Schneider; Omar Hyder; Benjamin S Brooke; Jonathan Efron; John L Cameron; Barish H Edil; Richard D Schulick; Michael A Choti; Christopher L Wolfgang; Timothy M Pawlik Journal: J Am Coll Surg Date: 2012-01-29 Impact factor: 6.113
Authors: Matthias Turina; Feza H Remzi; David W Dietz; Ravi Pokala Kiran; Dilara Seyidova-Khoshknabi; Jeff P Hammel; Jon D Vogel Journal: J Am Coll Surg Date: 2013-08 Impact factor: 6.113
Authors: Abhiram Sharma; Andrew-Paul Deeb; James C Iannuzzi; Aaron S Rickles; John R T Monson; Fergal J Fleming Journal: Ann Surg Date: 2013-08 Impact factor: 12.969
Authors: David S Morris; Jeff Rohrbach; Mary Rogers; Latha Mary Thanka Sundaram; Seema Sonnad; Jose Pascual; Babak Sarani; Patrick Reilly; Carrie Sims Journal: J Surg Res Date: 2011-05-19 Impact factor: 2.192
Authors: Andre da Luz Moreira; Ravi P Kiran; Hasan T Kirat; Feza H Remzi; Daniel P Geisler; James M Church; Thomas Garofalo; Victor W Fazio Journal: Surg Endosc Date: 2009-12-24 Impact factor: 4.584
Authors: Gabriela Batista Rodríguez; Andrea Balla; Santiago Corradetti; Carmen Martinez; Pilar Hernández; Jesús Bollo; Eduard M Targarona Journal: Int J Colorectal Dis Date: 2018-04-06 Impact factor: 2.571