Patel Supriya S, Patel Madhukar S, Mahanti Sanjit, Ortega Adrian, Ault Glenn T, Kaiser Andreas M, Senagore Anthony J
Division of Colorectal Surgery, University of Southern California, Los Angeles, CA 90033, USA.
Am Surg. 2012 Oct;78(10):1063-5.
Laparoscopic surgery is associated with decreased hospital length of stay, improved perioperative morbidity, and faster return to work compared with open procedures. Despite these benefits, laparoscopy has not been universally adopted with recent implementation estimates ranging from 10 to 30 per cent. The purpose of this study was to analyze the adoption of laparoscopic techniques for colon resections in California in 2009 based on institutional colectomy volume status. A total of 14,736 patients from 320 hospitals was analyzed. The laparoscopic to open case ratios for the low (zero to 17 cases/year), medium (18 to 50 cases/year), and high (greater than 50 cases/year) volume centers were: 0.32, 0.50, and 0.92, respectively. Although the data confirmed that a laparoscopic approach reduced length of stay (LOS) regardless of volume, lower adopters of laparoscopic colectomy had a longer overall total LOS, likely related to preponderance of open cases. Therefore, the data show that higher-volume institutions appear to have implemented laparoscopic colectomy for more of their case volume, and this adoption may account for the better institutional outcomes observed in these centers.
与开放手术相比，腹腔镜手术具有缩短住院时间、降低围手术期发病率以及更快恢复工作的优点。尽管有这些益处，但腹腔镜手术尚未得到普遍采用，最近的实施率估计在10%至30%之间。本研究的目的是根据机构结肠切除术数量状况，分析2009年加利福尼亚州结肠切除术腹腔镜技术的采用情况。共分析了来自320家医院的14736例患者。低（每年0至17例）、中（每年18至50例）、高（每年超过50例）手术量中心的腹腔镜与开放手术病例比分别为：0.32、0.50和0.92。尽管数据证实，无论手术量多少，腹腔镜手术方法均能缩短住院时间，但腹腔镜结肠切除术采用率较低的机构总体住院时间更长，这可能与开放手术病例占优势有关。因此，数据表明，手术量较高的机构似乎对更多病例实施了腹腔镜结肠切除术，而这种采用情况可能是这些中心观察到更好的机构治疗效果的原因。
