Hospital volume as a surrogate for laparoscopically assisted colectomy.
BACKGROUND
Although laparoscopic colectomy is reported to have favorable outcomes compared with open colectomy, it has yet to gain widespread acceptance in the United States. This study sought to investigate whether hospital volume is a factor determining the use of laparoscopy for colectomy.


METHODS
Using the Nationwide Inpatient Sample (NIS, 1998-2006), patients undergoing elective colon resection with and without laparoscopy were identified. Unique hospital identifiers were used to divide hospital volume into equal thirds, with the highest third defined as high volume and the lower two-thirds defined as low volume. The primary end point was the use of laparoscopy after adjustment for patient and hospital covariates.


RESULTS
A total of 209,769 colon resections were performed in the study period. Overall, only 8,407 (4%) of these resections were performed with laparoscopy. High-volume centers, which tended to be large, urban teaching hospitals, treated more patients in the highest income bracket and patients with private insurance than low-volume hospitals (p < 0.0001). High-volume hospitals used laparoscopy more often than low-volume hospitals (5.2% vs. 3.4%). After adjustment for covariates using multivariate analysis and propensity scores, analysis showed that patients with private insurance and those in the highest income bracket were more likely to receive laparoscopy (p < 0.0009). High-volume hospitals were more likely to perform laparoscopically assisted colectomy than low-volume hospitals (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.23-1.56).


CONCLUSIONS
Socioeconomic differences appear to exist between high- and low-volume hospitals in the use of laparoscopy. High hospital volume is associated with an increased likelihood that colectomy will be performed with laparoscopy.
Singla
Anand
A
Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, 55 Lake Avenue North, S6-432, Worcester, MA 01655, USA.
Simons
Jessica P
JP
Carroll
James E
JE
Li
Youfu
Y
Ng
Sing Chau
SC
Tseng
Jennifer F
JF
Shah
Shimul A
SA
D000368:Aged; D016009:Chi-Square Distribution; D003082:Colectomy / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D057216:Propensity Score; D014481:United States
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