Variations in Laparoscopic Colectomy Utilization in the United States

Abstract

Background: Recent published articles reported a wide geographic variation in the utilization of laparoscopic colectomy in the United States.

Objectives: This study aimed to report the current rates of laparoscopic colon resection in different types of hospitals in the United States.

Design: The Nationwide Inpatients Sample database was used to examine the clinical data of patients undergoing elective colon resection for the diagnosis of colon cancer or diverticular disease from 2009 to 2012.

Setting: Multivariate regression analysis was performed to compare different hospital types and regions regarding the utilization of laparoscopy.

Patients: Patients undergoing elective colon resection for the diagnosis of colon cancer or diverticular disease from 2009 to 2012 were selected.

Main outcome measures: The primary outcome measured was the rates of laparoscopic colon resection in different types of hospitals.

Results: We sampled a total of 309,816 patients who underwent elective colon resection. Of these, 171,666 (55.4%) had a laparoscopic operation. The utilization of a laparoscopic approach increased from 51.3% in 2009 to 59.3% in 2012. The increased utilization of a laparoscopic approach was seen in both urban (53.6% vs 61.6%) and rural hospitals (33.4% vs 42.3%), for colon cancer (45% vs 53.5%), and diverticular disease (61.9% vs 68.2%). The conversion rate to open surgery for diverticular disease was significantly higher than for colon cancer (adjusted odds ratio (AOR), 1.23; p < 0.01). After adjustment, urban hospitals (AOR, 2.13; p < 0.01), teaching hospitals (AOR, 1.13; p < 0.01), and large hospitals (AOR, 1.33; p < 0.01) had a greater utilization of laparoscopic surgery.

Limitations: This study was limited by its retrospective nature.

Conclusions: Although we have finally reached the point where a majority of patients undergoing an elective colectomy for diverticular disease and colon cancer receive a laparoscopic operation, there is wide variation in the implementation of laparoscopic surgery in colon resection in the United States. The utilization of a laparoscopic approach has associations with hospital factors such as size, teaching status of the hospital, and geographic location (urban vs rural).