Goldberg Drew W, Williams Shane, Sharpe James, Bleier Joshua, Saur Nicole, Kelz Rachel R
Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19104, USA.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Surg Endosc. 2025 Jul 14. doi: 10.1007/s00464-025-11888-x.
Outpatient colectomy has been shown to be safe and effective in small, single or multicenter institutional series. Early discharge following colorectal surgery has been made possible, in part, by standardization of perioperative care and postoperative monitoring. We examined modern national trends in the use of outpatient right colectomy (ORC) to inform future practice patterns.
We performed a retrospective cohort study of adult patients undergoing elective ORC using the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery and Services Databases from 2016 to 2021. Data were linked to the American Hospital Association survey to calculate cost in 2021 US dollars. Outpatient surgery was defined as a length of stay ≤ 1 day. The primary outcomes were the annual frequency of ORC and annual proportion of ORC per total colectomies. The Cochran-Armitage test of trend was used to compare annual frequency and proportion of ORC. Regression models were used to assess total admission cost and 30-day readmission by year. Spearman's correlation assessed annual trends.
Of 49,416 right colectomies meeting the study criteria, 1933 (3.9%) underwent ORC. The ORC median [IQI] patient age was 63 [54, 70] years and 85.8% underwent a minimally invasive approach. There was a significant increase in the annual frequency (p = 0.03) and proportion (p < 0.001) of ORC over time. There were no significant differences in 30-day readmission rates over time (p = 0.44). A significant increase in risk-adjusted yearly total cost for ORC was identified, ranging from $9,447 in 2016 to $14,544 in 2021 (Spearman's correlation test rho = 1, p = 0.003).
In a contemporary geographically representative cohort, the practice of ORC increased over five years without differences in readmission rates. ORC cost increases potentially indicate an increased resource requirement to provide acute postoperative care in the ambulatory setting.
在小型单中心或多中心机构研究中，门诊结肠切除术已被证明是安全有效的。结直肠手术后的早期出院在一定程度上得益于围手术期护理和术后监测的标准化。我们研究了门诊右半结肠切除术（ORC）使用情况的现代全国趋势，以为未来的实践模式提供参考。
我们使用2016年至2021年医疗成本和利用项目的州住院数据库以及州门诊手术和服务数据库，对接受择期ORC的成年患者进行了一项回顾性队列研究。数据与美国医院协会调查相关联，以计算2021年美元的成本。门诊手术定义为住院时间≤1天。主要结局是ORC的年度频率和ORC占总结肠切除术的年度比例。采用趋势Cochran-Armitage检验比较ORC的年度频率和比例。使用回归模型评估每年的总入院成本和30天再入院情况。Spearman相关性分析评估年度趋势。
在49416例符合研究标准的右半结肠切除术中，1933例（3.9%）接受了ORC。ORC患者的年龄中位数[四分位间距]为63[54,70]岁，85.8%采用了微创方法。随着时间的推移，ORC的年度频率（p = 0.03）和比例（p < 0.001）显著增加。30天再入院率随时间无显著差异（p = 0.44）。确定ORC的风险调整后年度总成本显著增加，从2016年的9447美元到2021年的14544美元（Spearman相关性检验rho = 1，p = 0.003）。
在一个具有当代地理代表性的队列中，ORC的应用在五年内有所增加，而再入院率没有差异。ORC成本的增加可能表明在门诊环境中提供急性术后护理需要更多资源。
