The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes.
Population-based studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections. As such, data assessing non-elective laparoscopic colectomies are limited. Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USA.



A national inpatient database was reviewed from 2008 to 2011 for right, left, and sigmoid colectomies in the non-elective setting. Cases were stratified by approach into open or laparoscopic groups. Demographics, perioperative clinical variables, and financial outcomes were compared across each group.



A total of 22,719 non-elective colectomies were analyzed. The vast majority (95.8 %) was open. Most cases were performed in an urban setting at non-teaching hospitals by general surgeons. Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons (p < 0.001). Demographics were similar between open and laparoscopic groups; however, the disease distribution by approach varied, with significantly more severe cases in the open colectomy arm (p < 0.001). Cases performed laparoscopically had significantly better mortality and complication rates. Laparoscopic cases also had significantly improved outcomes, including shorter length of stay and hospital costs (all p < 0.001).



Our analysis revealed less than 5 % of urgent and emergent colectomies in the USA are performed laparoscopically. Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons. Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication rates, and lower costs. Increased adoption of laparoscopy in the non-elective setting should be considered.
Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA. debby_keller@hotmail.com.
Deborah S
DS
Keller
Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
Rodrigo
R
Pedraza
Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.
Juan Ramon
JR
Flores-Gonzalez
Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.|Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
Jean Paul
JP
LeFave
Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.|Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA.|Houston Methodist Hospital, Houston, TX, USA.
Ali
A
Mahmood
Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA.|Minimally Invasive Colorectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA.|Houston Methodist Hospital, Houston, TX, USA.
Eric M
EM
Haas
D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D066231:Surgeons / Q000706:statistics & numerical data; D014481:United States
Colon and rectal surgery; Emergency surgery; Emergent colectomy; Healthcare outcomes; Laparoscopic surgery