title: Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers.
abstract: OBJECTIVE
  This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR).
  
  
  METHODS
  This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals.
  
  
  RESULTS
  A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium- to large-sized hospitals (47.0%-49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95% CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay.
  
  
  CONCLUSIONS
  There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.
authors.affiliation: Departments of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Simorov
authors.forename: Abhijit
authors.initials: A
authors.lastname: Shaligram
authors.forename: Valerie
authors.initials: V
authors.lastname: Shostrom
authors.forename: Eugene
authors.initials: E
authors.lastname: Boilesen
authors.forename: Jon
authors.initials: J
authors.lastname: Thompson
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D003108:Colonic Diseases / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020379:Risk Adjustment; D014481:United States; D055815:Young Adult