National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches.
OBJECTIVE
The laparoscopic approach to Crohn's disease has demonstrated benefits in several small series. We sought to examine its use and outcomes on a national level.


METHODS
All admissions with a diagnosis of Crohn's disease requiring bowel resection were selected from the 2000-2004 Nationwide Inpatient Sample. Regression analyses were used to compare outcome measures and identify independent predictors of undergoing laparoscopy.


RESULTS
Of 396,911 patients admitted for Crohn's disease, 49,609 (12%) required surgical treatment. They were predominately Caucasian (64%), female (54%), and with ileocolic disease (72%). Most had private insurance (71%) and had surgery in urban hospitals (91%). Laparoscopic resection was performed in 2,826 cases (6%) and was associated with lower complications (8% vs. 16%), shorter length of stay (6 vs. 9 days), lower charges ($27,575 vs. $38,713), and mortality (0.2% vs. 0.9%, all P < 0.01). Open surgery was used more often for fistulas (8% vs. 1%) and when ostomies were required (12% vs. 7%). Independent predictors of laparoscopic resection were age <35 [odds ratio (OR) = 2.4], female gender (OR = 1.4), admission to a teaching hospital (OR = 1.2), ileocecal location (OR = 1.5), and lower disease stage (OR = 1.1, all P < 0.05). Ethnic category, insurance status, and type of admission (elective vs. non-elective) were not associated with operative method (P > 0.05).


CONCLUSIONS
A variety of patient- and system-related factors influence the utilization of laparoscopy in Crohn's disease. Laparoscopic resection is associated with excellent short-term outcomes compared to open surgery.
Lesperance
Kelly
K
Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA. kelly025@comcast.net
Martin
Matthew J
MJ
Lehmann
Ryan
R
Brounts
Lionel
L
Steele
Scott R
SR
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003108:Colonic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D017281:Cost of Illness; D003424:Crohn Disease / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007077:Ileal Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult