Kang Celeste Y, Halabi Wissam J, Luo Ruihong, Pigazzi Alessio, Nguyen Ninh T, Stamos Michael J
Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA.
Arch Surg. 2012 Aug;147(8):724-31. doi: 10.1001/archsurg.2012.358.
The latest trends of laparoscopic colorectal surgery (LCRS) after the introduction of International Classification of Diseases, Ninth Revision laparoscopic procedure codes in 2008 remains unknown. This study evaluates LCRS trends before and after the application of specific codes for LCRS.
Retrospective analysis of elective surgery for colon cancer, rectal cancer, and diverticulitis using Nationwide Inpatient Sample data from 2007 and 2009.
Primary outcome measures included in-hospital mortality, length of stay, and total charge.
A total of 126 921 patients in 2007 and 117 177 patients in 2009 underwent colorectal surgery. Laparoscopic colorectal surgery increased dramatically from 13.8% in 2007 to 42.6% in 2009 (P.01). This trendwas disease and procedure specific. When compared with 2007, patients who underwent LCRS in 2009 had lower conversion rates (14.8% vs 32.1%, P.001). In 2009, LCRS had lower in-hospital mortality (0.5% vs 1.1%, P.001) and a shorter length of hospital stay (5 vs 6 days, P.001) compared with open surgery. In 2009, when compared with successful LCRS, conversion to open surgery was associated with a longer length of hospital stay (6 vs 5 days, P.01), increased hospital charges, and increased mortality (0.7% vs 0.5%, P.01).
The marked increase in LCRS when comparing these 2 years is unlikely only due to the changing practice of colorectal surgery but brings into question the accuracy of data prior to 2009. Our report of Nationwide Inpatient Sample 2009 data represents the most accurate reflection of the use of LCRS in the United States. These data can serve as a benchmark for future comparative studies.
2008年引入国际疾病分类第九版腹腔镜手术编码后，腹腔镜结直肠手术（LCRS）的最新趋势仍不明确。本研究评估了LCRS特定编码应用前后的LCRS趋势。
利用2007年和2009年全国住院患者样本数据对结肠癌、直肠癌和憩室炎的择期手术进行回顾性分析。
主要观察指标包括住院死亡率、住院时间和总费用。
2007年共有126921例患者，2009年有117177例患者接受了结直肠手术。腹腔镜结直肠手术从2007年的13.8%急剧增加到2009年的42.6%（P<0.01）。这种趋势具有疾病和手术特异性。与2007年相比，2009年接受LCRS的患者转化率较低（14.8%对32.1%，P<0.001）。2009年，与开放手术相比，LCRS的住院死亡率较低（0.5%对1.1%，P<0.001），住院时间较短（5天对6天，P<0.001）。2009年，与成功的LCRS相比，转为开放手术与更长的住院时间（6天对5天，P<0.01）、更高的住院费用和更高的死亡率（0.7%对0.5%，P<0.01）相关。
比较这两年LCRS的显著增加不太可能仅仅是由于结直肠手术实践的变化，而是对2009年之前数据的准确性提出了质疑。我们对2009年全国住院患者样本数据的报告代表了美国LCRS使用情况的最准确反映。这些数据可作为未来比较研究的基准。
