title: Hospital-level outcomes associated with laparoscopic colectomy for cancer in the minimally invasive era.
abstract: BACKGROUND
  Compared to the open approach, randomized trials have shown that laparoscopic colectomy is associated with a shorter hospitalization without increases in morbidity or mortality rates. With broader adoption of laparoscopic colectomy for cancer in the USA, it is unclear if laparoscopic colectomy continues to be associated with shorter hospitalization and comparable morbidity.
  
  
  OBJECTIVE
  The purpose of this study is to determine if hospitals where a greater proportion of colon resections for cancer are approached laparoscopically (laparoscopy rate) achieve improved short-term outcomes compared to hospitals with lower laparoscopy rates.
  
  
  METHODS
  From the 2008-2009 Nationwide Inpatient Sample, we identified hospitals where ≤ 12 colon resections for cancer were reported with ≥ 1 approached laparoscopically. We assessed the correlation between a hospital's laparoscopy rate and risk-standardized outcomes (intra- and postoperative morbidity, in-hospital mortality rates, and average length of stay).
  
  
  RESULTS
  Overall, 6,806 colon resections were performed at 276 hospitals. Variation was noted in hospital laparoscopy rates (median = 52.0 %, range = 3.8-100 %) and risk-standardized intra- (2.7 %, 1.8-8.6 %) and postoperative morbidity (27.8 %, 16.4-53.4 %), in-hospital mortality (0.7 %, 0.3-42.0 %), and average length of stay (7.0 days, 4.9-10.3 days). While no association was noted with in-hospital mortality, higher laparoscopy rates were correlated with lower postoperative morbidity [correlation coefficient (r) = -0.12, p = 0.04) and shorter hospital stays (r  = -0.23, p  <  0.001), but higher intraoperative morbidity (r  =  0.19, p  <  0.001) rates. This was not observed among hospitals with high procedure volumes.
  
  
  CONCLUSIONS
  Higher laparoscopy rates were associated with only slightly lower postoperative morbidity rates and modestly shorter hospitalizations.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale School of Medicine, 333 Cedar Street, SHM-1E-61, PO Box 208088, New Haven, CT 06520-8088, USA. justin_p_fox@yahoo.com
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care