title: Can laparoscopy for colon resection reduce the need for discharge to skilled care facility?
abstract: BACKGROUND
  A significant proportion of patients, especially the elderly undergoing colon resections, are likely to be discharged to a skilled care facility. This study aims to examine whether the technique of colectomy, open versus laparoscopic, contributed to their discharge to a skilled care facility.
  
  
  METHODS
  This was a retrospective analysis using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Adult patients who underwent colectomy in 2009 were evaluated. SAS and SUDAAN software were used to provide weighted estimates and to account for the complex sampling design of the NIS. We compared routine discharge to nonroutine discharge, defined as transfer to short-term hospital, skilled nursing facility, intermediate care, home health, or another type of facility.
  
  
  RESULTS
  A weighted total of 221,294 adult patients underwent colectomy in 2009 and had the primary outcome of discharge available. Of these colon resections, 70,361 (32 %) were performed laparoscopically and 150,933 (68 %) by open technique. A total of 139,047 (62.8 %) patients had routine discharge and 73,572 (33.3 %) nonroutine. A total of 8,445 (3.8 %) patients died while in the hospital, and 229 (0.1 %) left against medical advice and were excluded from further analysis. On univariate analysis, age ≥ 65 years, female gender, Black/Hispanic race, open technique (compared to laparoscopic), Medicare/Medicaid insurance status, comorbidity index of ≥ 1, and malignant primary diagnosis predicted nonroutine discharge. A multivariate logistic model was then used to predict nonroutine discharge in these patients using variables significant in the univariate analysis at the α = 0.05 significance level. In the multivariate analysis, open compared to laparoscopic technique was independently associated with increased likelihood of discharge to skilled care facilities (odds ratio 2.85, 95 % confidence interval 2.59-3.14).
  
  
  CONCLUSIONS
  In addition to the expected factors like advancing age, female gender, and increasing comorbidity index, open compared to laparoscopic technique for colectomy is associated with an increased likelihood of discharge to skilled care facilities. When feasible, the laparoscopic technique should be considered as an option, especially in the elderly patients who require colon resection, because it may reduce their likelihood of discharge to a skilled care facility.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Shaligram
authors.forename: Lynette
authors.initials: L
authors.lastname: Smith
authors.forename: Pradeep
authors.initials: P
authors.lastname: Pallati
authors.forename: Anton
authors.initials: A
authors.lastname: Simorov
authors.forename: Jane
authors.initials: J
authors.lastname: Meza
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000368:Aged; D003082:Colectomy / Q000191:economics / Q000379:methods* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States