Clinical Outcomes and Resource Utilization Associated With Laparoscopic and Open Colectomy Using a Large National Database

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Abstract
To clarify national clinical and economic laparoscopic colectomy outcomes, we conducted a study of patients who underwent colectomy by laparoscopic or open approaches. Laparoscopy is becoming the preferred approach for colectomy in benign and malignant diseases. Although it is associated with significant clinical benefits, economic outcomes have varied. We analyzed cohorts of patient-level data from Premier Inc.'s Perspective Rx Comparative Database, which collects data from more than 500 hospitals throughout the United States. By reviewing hospital charge data, patients who underwent elective colectomies from July 1, 2004, through June 30, 2006, were identified using International Classification of Diseases, 9th Revision, Clinical Modification procedure codes. The colectomy had to be listed as the primary or secondary procedure of the hospitalization. Primary outcomes included transfusion rates, in-hospital complications, readmissions within 30 days, reoperations, length of stay, total hospitalization costs, and discharge dispositions and services. We identified 32,733 patients who had elective colectomies throughout 402 hospitals; 11,044 (33.7%) were laparoscopic and 21,689 (66.3%) were open colectomies. The mean age was 64.2 +/- 13.9 years and 53.8% were women. Laparoscopic colectomy patients had a longer mean operative time (195 +/- 76 vs. 178 +/- 80 minutes; P < 0.0001) and higher total hospital costs ($8076 vs. $7678; P = 0.0002). Laparoscopic patients had shorter mean length of stay (7.0 vs. 8.1; P < 0.0001) and fewer mean intensive care unit days (0.7 +/- 3.8 vs. 1.3 +/- 5.2 days; P < 0.0001). The laparoscopic cohort also had lower rates of transfusions (odds ratio [OR] = 0.68; P < 0.0001), in-hospital complications (OR = 0.89; P < 0.0001), and readmissions within 30 days (OR = 0.89; P = 0.0051), although reoperation rates were slightly, but significantly increased (OR = 1.78; P = 0.002). Laparoscopic colectomy patients were more likely to be discharged home without nursing care (OR = 0.70; P < 0.0001). Evaluation of a national administrative data set showed that patients who underwent laparoscopic colectomy had shorter intensive care unit and total hospital stays, fewer complications, lower mortality, fewer readmissions, and less use of skilled nursing facilities after discharge. There was a small but significant increase in reoperation rates and in-hospital costs with laparoscopic colectomy. Improved application of enhanced recovery programs and operative efficiencies may further improve resource utilization associated with laparoscopic colectomy.