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Laparoscopic Colon Resection - Trends in Utilization and Rate of Conversion to Open Procedure: A Large Multicenter Outcome Study
Anton Simorov*, Ahbijit Shaligram*, Avishai Meyer*, Pradeep Pallati*, Jon Thompson, Dmitry Oleynikov*
University of Nebraska Medical Center, Omaha, NE

Background: This study aims to examine trends of utilization and rate of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR).
Method: This study is a multi-center, retrospective analysis utilizing University Health System Consortium (UHC) administrative database. UHC is an alliance of over 200 academic and affiliate hospitals.
Results: 71709 patients underwent colon resections between October 2008 and June 2011. LCR was attempted in 30,130(42%) patients with 4,765(15.8%) among these needing conversion to an open procedure. There was a trend towards increasing utilization of LCR from 37.51% in 2008 to 44.40% in 2011(p=0.0001). Inflammatory bowel disease was treated equally by open and LCR. Attempted laparoscopic (ileo)cecectomy had highest rate of conversion (24.73%) followed by transverse(21.6%), left (20.9%), right(15.4%) and sigmoid(14.5%) colon. As expected, compared to open, patients undergoing LCR or needing conversion to open had better outcomes.
Conclusion: There is trend of increasing utilization of LCR with acceptable conversion rate across hospitals in United Sates over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.
Table: Comparison of perioperative outcomes for patients undergoing laparoscopic colon resection or needing conversion and those undergoing open colectomy
OutcomesLCR
(n=30,130 )
OC
(n=41, 579 )
P value
Mortality (%)0.585.250.0001
Morbidity (%)9.1221.510.0001
LOS (Days, Mean ±S.D.)6.77±6.4012.41±13.840.0001
30-day Readmission (%)4.936.990.0001
Cost ± S.D. (US \013,408±13,25724,351±32,4660.0001
ICU admission (%)10.1137.120.0001

LCR; laparoscopic colon resection, OC; Open colectomy, LOS; length of stay, SD; Standard Deviation, ICU; Intensive Care Unit


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