Adoption of Laparoscopy for Elective Colorectal Resection: A Report from the Surgical Care and Outcomes Assessment Program

详细信息	查看全文 | 推荐本文 |

• 作者：The Surgical Care ; Outcomes Assessment Program (SCOAP) Collaborative ; Steve Kwon ; MD ; MPH^a ; Richard Billingham ; MD ; FACS^b ; Ellen Farrokhi ; MD ; FACS^c ; Michael Florence ; MD ; FACS^b ; Daniel Herzig ; MD ; FACS^f ; Karen Horvath ; MD ; FACS^a ; Terry Rogers ; MD^c ; Scott Steele ; MD ; FACS^e ; Rebecca Symons ; MPH^a ; Richard Thirlby ; MD ; FACS^d ; Mark Whiteford ; MD ; FACS^g ; David R. Flum ; MD ; MPH ; FACS^a ; ^{daveflum@u.washington.edu}
• 关键词：CAE ; composite of adverse events ; OR ; odds ratio ; SCOAP ; Surgical Care and Outcomes Assessment Program
• 刊名：Journal of the American College of Surgeons
• 出版年：2012
• 期刊代码：175_10727515
• 类别：med
• 出版时间：June, 2012
• 卷：214
• 期：6
• 页码：909-918.e1
• 文件大小：540 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences

Background

The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large.

Study Design

The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4^th quarter of 2005 through 4^th quarter of 2010.

Results

Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 卤 15.6 years; 55.2%women), 38.0%were performed laparoscopically (17.8%laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3%in 4^th quarter of 2005 to 41.6%in 4^th quarter of 2010 (trend during study period, p < 0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95%CI, 0.39鈭?.7), wound infections (OR = 0.45; 95%CI, 0.34鈭?.61), and composite of adverse events (OR = 0.58; 95%CI, 0.43鈭?.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4%increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology.

Conclusions

The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.