Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Bastawrous, Amir L.; Shih, I‐Fan; Li, Yanli; Cleary, Robert K.

doi:10.1016/j.amjsurg.2019.11.030

Cited by 7 publications

(8 citation statements)

References 29 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 longterm MIS colectomy benefits that include faster recovery with fewer complications and less pain [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 91%

“…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: 91%

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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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“…Previous studies reported that robotic-assisted surgery is associated with reduced postoperative pain [ 5 , 6 ]. However, there is limited literature examining the potential benefit of the robotic approach in reducing short-term and long-term opioid use [ 7 , 8 ], particularly for colectomies.…”

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confidence: 99%

A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use

et al. 2021

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Background Opioid dependence is a public health crisis and surgery is a risk factor for long-term opioid use. Though minimally invasive surgery (MIS) is associated with less perioperative pain, demonstrating an association with less long-term opioid use would be another reason to justify adoption of minimally invasive techniques. We compared the rates for long-term opioid prescriptions among patients in a large national database who underwent minimally invasive and open colectomy. Methods Using the MarketScan Database, we retrospectively analyzed patients undergoing colon resection for benign and malignant diseases between 2013 and 2017. Among opioid-naïve patients who had ≥ 1 opioid prescriptions filled perioperatively (30 days before surgery to 14 days after discharge), propensity score matching was applied for group comparisons [open (OS) versus MIS, and laparoscopic (LS) versus robotic-assisted surgery (RS)]. The primary outcome was long-term opioid use defined as the proportion of patients with ≥ 1 long-term opioid prescriptions filled 90–180 days after discharge. Risks factors for long-term opioid use were assessed using logistic regression. Results Among the 5413 matched pairs in the MIS versus OS cohorts, MIS significantly reduced long-term opioid use of ‘any opioids’ (13.3% vs. 20.9%), schedule II/III opioids (11.7% vs. 19.2%), and high-dose opioids (4.3% vs. 7.7%; all p < 0.001). Among the 1195 matched pairs in the RS versus LS cohorts, RS was associated with less high-dose opioids (2.1% vs. 3.8%, p = 0.015) 90–180 days after discharge. Other risk factors for long-term opioid use included younger age, benign indications, tobacco use, mental health conditions, and > 6 Charlson comorbidities. Conclusion Minimally invasive colectomy is associated with a significant reduction in long-term opioid use when compared to OS. Robotic-assisted colectomy was associated with less high-dose opioids compared to LS. Increasing adoption of minimally invasive surgery for colectomy and including RS, where appropriate, may decrease long-term opioid use.

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“…In an analysis of thoracic lobectomy procedures from the Premier database, robotic patients received opioids less frequently, and with lower total and average daily doses, compared to those undergoing VATS and open procedures [ 24 ]. In a similar analysis of sigmoidectomies, robotic patients were administered lower doses of parenteral opioids in comparison to open or laparoscopic patients [ 25 ]. These findings are consistent with the results of an analysis within our own institution, where we found that minimally invasive techniques were associated with a reduced risk of prolonged opioid use [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

et al. 2022

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Background As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures. Methods We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting. Results MIS patients had shorter LOS compared to open approach: − 1.87 days for lobectomy, − 1.34 days for colon resection, − 0.47 days for rectal resection, and − 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: − 0.13 days for lobectomy, − 0.28 days for colon resection, − 0.67 days for rectal resection, and − 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates. Conclusion Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.

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Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Cited by 7 publications

References 29 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

A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

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