Risk of readmission after laparoscopic vs. open colorectal surgery.
OBJECTIVE
Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well characterized. The aim of this study is to compare the risk of readmission after the two procedures in a large, nationally representative sample.


METHODS
Patients who underwent colorectal resection in 2011 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. LC and OC patients were compared for patient factors, complications, and readmission rates. A multivariable analysis controlling for significant factors was performed to evaluate factors associated with readmission.


RESULTS
Of 30,428 patients who underwent colorectal resection, 40.2% underwent LC. Length of stay (LOS) after LC was shorter than after OC (5.7 vs. 9.7 days, p < 0.001). LC was associated with a significantly lower rate of surgical site infections (SSI), bleeding, reoperation, 30-day mortality, and complications. Risk of readmission was greater for patients undergoing proctectomy than colectomy (12.7 vs. 10.6 %, p < 0.001), but was lower after laparoscopic than open for both procedures after controlling for confounding factors. Obesity, DM, operating time ≥180 min, steroid use, and ASA class 3-5 were found to be associated with readmission.


CONCLUSIONS
Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.
Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA.
Iyare O
IO
Esemuede
Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA.
Alodia
A
Gabre-Kidan
Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA.
Dennis L
DL
Fowler
Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu.
Ravi P
RP
Kiran
D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D003108:Colonic Diseases / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D008297:Male; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000209:etiology; D012002:Rectal Diseases / Q000601:surgery; D012044:Regression Analysis; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology
Laparoscopy; NSQIP; Quality; Readmission