title: Laparoscopic versus open colon resections in California: a cross-sectional analysis.
abstract: Laparoscopic surgery is associated with decreased hospital length of stay, improved perioperative morbidity, and faster return to work compared with open procedures. Despite these benefits, laparoscopy has not been universally adopted with recent implementation estimates ranging from  10 to 30 per cent. The purpose of this study was to analyze the adoption of laparoscopic techniques for colon resections in California in 2009 based on institutional colectomy volume status. A total of 14,736 patients from 320 hospitals was analyzed. The laparoscopic to open case ratios for  the low (zero to 17 cases/year), medium (18 to 50 cases/year), and high (greater than 50 cases/year) volume centers were: 0.32, 0.50, and 0.92, respectively. Although the data confirmed that a laparoscopic approach reduced length of stay (LOS) regardless of volume, lower adopters of laparoscopic  colectomy had a longer overall total LOS, likely related to preponderance of open cases. Therefore, the data show that higher-volume institutions appear to have implemented laparoscopic colectomy for more of their case volume, and this adoption may account for the better institutional outcomes  observed in these centers.
authors.affiliation: Division of Colorectal Surgery, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Supriya S
authors.initials: SS
authors.lastname: Patel
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.forename: Sanjit
authors.initials: S
authors.lastname: Mahanti
authors.forename: Adrian
authors.initials: A
authors.lastname: Ortega
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Ault
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Kaiser
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
mesh_terms: D002140:California; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006801:Humans; D010535:Laparoscopy