A Regional and National Database Comparison of Colorectal Outcomes

Batool, Farwa; Collins, Stacey D.; Albright, Jeremy J.; Ferraro, Jane; Wu, Juan; Krapohl, Greta L.; Campbell, Darrell A.; Cleary, Robert K.

doi:10.4293/jsls.2018.00031

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…In addition, RS patients had shorter mean index hospital LOS, lower conversion-to-open surgery rates and less mean hospital outpatient visits after surgery when compared to the LS group. These findings likely reflect long-term MIS colectomy benefits that include faster recovery with fewer complications and less pain [ 1 – 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…The development and introduction of minimally invasive surgery (MIS) tools and approaches have fundamentally changed colorectal surgery. MIS approaches to colorectal surgery offer several outcomes advantages over traditional open surgery (OS) that include earlier return of bowel function, less postoperative pain and opioid use, shorter hospital length of stay (LOS), and fewer surgical site infections [1][2][3][4][5]. The adoption of the MIS approach to colorectal surgery increased from 40 to 60% in 2011 to 75% in 2018 [6].…”

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confidence: 99%

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Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

et al. 2022

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Background Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease. Methods This is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting. Results Of 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, − 1.71, p < 0.001) and lower average total expenditures (mean difference, − $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, − 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, − 0.31, p = 0.001) at 365 days than LS. Conclusion MIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

et al. 2022

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“…First, the cohort in this study was limited to patients and surgeons in Michigan, and therefore these results may not be generalizable to other settings. Nevertheless, previous work suggests that practice patterns and patient characteristics within the MSQC clinical registry used here are like those of nationally representative data 44. Second, the MSQC registry is a sampling database, and therefore not all cases a given surgeon performs are captured.…”

Section: Discussionmentioning

confidence: 99%

The Measurement Reliability of Complications and Patient Satisfaction After Common Surgical Procedures

2022

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Objective: To evaluate the reliability of surgeon outcomes. Background: Surgeons’ outcomes are now widely used in public reporting and value-based reimbursement, but the reliability of these measures continues to raise concerns. Methods: We performed a retrospective study of surgeons performing cholecystectomy, colectomy, and hernia repair on adult patients between January 1, 2017, and December 31, 2020. Outcomes were risk-adjusted rates of complications and high patient satisfaction. We estimated the reliability of each outcome, its relationship with case volume, and the number of surgeons who reached an acceptable level of reliability (≥0.70). Results: A total of 23,533 patients with a mean age of 56.8 (16.2) years and 10,191 (43.3%) females underwent operations by 333 surgeons. Risk-adjusted complication rate was 2.5% [95% confidence interval (CI): 2.2%–2.8%] and risk-adjusted high satisfaction rate was 79.9% (95% CI: 78.7%–81.0%). The reliability of the complication rate was 0.27 (95% CI: 0.25–0.29) and the reliability of the high satisfaction rate was 0.53 (95% CI: 0.50–0.55). Reliability increased with case volume; however, only 5 (1.5%) surgeons performed enough cases to reach acceptable reliability for their complication rate, while 86 (25.8%) surgeons reached acceptable reliability for their patient satisfaction rate. After adjustment for reliability, the range of complication rates decreased 29-fold from 0% to 14.3% to 2.4% to 2.9%, and the range of patient satisfaction decreased 2.6-fold from 25.3% to 100.0% to 64.9% to 92.4%. Conclusions: Among surgeons performing common operations, complications and patient satisfaction had relatively low reliability. Although reliability increased with volume, most surgeons had insufficient case volume to achieve acceptable reliability of their outcomes. As such, these measures likely offer little to no meaningful information to inform decision-making.

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“…Minimally invasive surgery in colorectal disease has been widely accepted as equivalent, if not better for patients than open surgery. 1,2 The advantages of minimally invasive surgery include decreased pain, decreased anastomotic leak, length of stay (LOS), wound complications, cardiac/pulmonary complications, and improved quality of life. [3][4][5][6][7][8] Robotic surgery has been shown effective in morbidly obese patients with only wound complications being significantly different between cohorts.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

McCarthy¹,

Gough²,

Johns³

et al. 2020

The American Surgeon™

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Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

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A Regional and National Database Comparison of Colorectal Outcomes

Cited by 7 publications

References 31 publications

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

The Measurement Reliability of Complications and Patient Satisfaction After Common Surgical Procedures

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

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