title: Laparoscopic Colorectal Surgery in the Emergency Setting: Trends in the Province of Ontario.
abstract: BACKGROUND
  The purpose of this study was to examine the adoption trends of emergency laparoscopic colorectal surgery in the province of Ontario.
  
  
  METHODS
  We conducted a retrospective time-series analysis examining rates of emergency colorectal surgery among 10.5 million adults in Ontario, Canada from April 1, 2002 to December 31, 2009. We linked administrative claims databases and the Ontario Cancer Registry to assess procedure rates over time. Procedure trends were assessed using time-series analysis.
  
  
  RESULTS
  Over the 8-year period, 29,676 emergency colorectal procedures were identified. A total of 2582 (8.7%) were performed laparoscopically and 27,094 (91.3%) were open. Open and laparoscopic patients were similar with respect age, sex, and Charlson Comorbidity Index. The proportion of surgery for benign (63.8% of open cases vs. 65.6% laparoscopic, standardized difference=0.04) and malignant disease (36.2% open vs. 34.4% laparoscopic, standardized difference=0.04) was equal between groups. The percentage of emergency colorectal surgery performed laparoscopically increased from 5.7% in 2002 to 12.0% in 2009 (P<0.01). The use of laparoscopy increased for both benign and malignant disease. Statistically significant upward trends in laparoscopic surgery were seen for inflammatory bowel disease (P<0.01), obstruction (P<0.01), and colon cancer (P<0.01). From 2002 to 2009, annual procedure rates increased at a greater rate in nonacademic centers (P<0.01).
  
  
  CONCLUSIONS
  Laparoscopic emergency colorectal surgery has increased significantly between 2002 and 2009 for both benign and malignant disease and for a wide range of diagnoses. This was driven in part by steadily rising usage of laparoscopy in nonacademic centers.
authors: *Division of General Surgery, University of Ottawa, Ottawa †Institute for Clinical and Evaluative Sciences ‡Leslie Dan Faculty of Pharmacy, University of Toronto §Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada ∥Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
authors: Reilly P
authors: RP
authors: Musselman
authors: Tara
authors: T
authors: Gomes
authors: Beverley P
authors: BP
authors: Chan
authors: Rebecca C
authors: RC
authors: Auer
authors: Husein
authors: H
authors: Moloo
authors: Muhammad
authors: M
authors: Mamdani
authors: Mohammed
authors: M
authors: Al-Omran
authors: Omar
authors: O
authors: Al-Obeed
authors: Robin P
authors: RP
authors: Boushey
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D003107:Colorectal Surgery / Q000639:trends*; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors