Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale School of Medicine, 333 Cedar Street, SHM-1E-61, PO Box 208088, New Haven, CT 06520-8088, USA.
J Gastrointest Surg. 2012 Nov;16(11):2112-9. doi: 10.1007/s11605-012-2018-z. Epub 2012 Sep 5.
Compared to the open approach, randomized trials have shown that laparoscopic colectomy is associated with a shorter hospitalization without increases in morbidity or mortality rates. With broader adoption of laparoscopic colectomy for cancer in the USA, it is unclear if laparoscopic colectomy continues to be associated with shorter hospitalization and comparable morbidity.
The purpose of this study is to determine if hospitals where a greater proportion of colon resections for cancer are approached laparoscopically (laparoscopy rate) achieve improved short-term outcomes compared to hospitals with lower laparoscopy rates.
From the 2008-2009 Nationwide Inpatient Sample, we identified hospitals where ≤ 12 colon resections for cancer were reported with ≥ 1 approached laparoscopically. We assessed the correlation between a hospital's laparoscopy rate and risk-standardized outcomes (intra- and postoperative morbidity, in-hospital mortality rates, and average length of stay).
Overall, 6,806 colon resections were performed at 276 hospitals. Variation was noted in hospital laparoscopy rates (median = 52.0 %, range = 3.8-100 %) and risk-standardized intra- (2.7 %, 1.8-8.6 %) and postoperative morbidity (27.8 %, 16.4-53.4 %), in-hospital mortality (0.7 %, 0.3-42.0 %), and average length of stay (7.0 days, 4.9-10.3 days). While no association was noted with in-hospital mortality, higher laparoscopy rates were correlated with lower postoperative morbidity [correlation coefficient (r) = -0.12, p = 0.04) and shorter hospital stays (r = -0.23, p < 0.001), but higher intraoperative morbidity (r = 0.19, p < 0.001) rates. This was not observed among hospitals with high procedure volumes.
Higher laparoscopy rates were associated with only slightly lower postoperative morbidity rates and modestly shorter hospitalizations.
与开放手术相比，随机试验表明腹腔镜结直肠切除术与住院时间缩短相关，而不会增加发病率或死亡率。随着腹腔镜结直肠切除术在美国更广泛地应用于癌症治疗，尚不清楚腹腔镜结直肠切除术是否仍与住院时间缩短和可比的发病率相关。
本研究旨在确定接受腹腔镜结直肠切除术治疗的癌症患者比例较高的医院（腹腔镜比例）与腹腔镜比例较低的医院相比是否能获得更好的短期结果。
从 2008-2009 年全国住院患者样本中，我们确定了报告有≤12 例结直肠癌切除术且≥1 例腹腔镜手术的医院。我们评估了医院的腹腔镜比例与风险标准化结果（围手术期发病率、住院死亡率和平均住院时间）之间的相关性。
共有 276 家医院进行了 6806 例结直肠切除术。医院的腹腔镜比例存在差异（中位数=52.0%，范围=3.8-100%），风险标准化的围手术期发病率（2.7%，1.8-8.6%）和术后发病率（27.8%，16.4-53.4%）、住院死亡率（0.7%，0.3-42.0%）和平均住院时间（7.0 天，4.9-10.3 天）也存在差异。虽然与住院死亡率无相关性，但较高的腹腔镜比例与较低的术后发病率（相关系数 r=-0.12，p=0.04）和较短的住院时间（r=-0.23，p<0.001）相关，而与较高的术中发病率（r=0.19，p<0.001）相关。在手术量较高的医院中未观察到这种相关性。
较高的腹腔镜比例与术后发病率略有降低和住院时间略有缩短相关。
