title: Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database.
abstract: Small-bowel obstruction (SBO) is a common disorder and constitutes a significant healthcare burden. Laparoscopic lysis of adhesions (LLOA) for SBO is predicted to decrease complications, shorten hospital stay, and cut healthcare costs compared with the open lysis of adhesions (OLOA); however, large comparison studies are lacking. We evaluated the nationwide adoption of LLOA and compared outcomes with OLOA. We retrospectively analyzed data from 9920 OLOA and 3269 LLOA cases from 2005 to 2013 using the American College of Surgeons prospective National Surgical Quality Improvement Program data set. Annual trends were evaluated using linear regression. Surgery outcomes were compared using two-sample t tests or Mann-Whitney tests. Post-surgical complications were compared using multivariable logistic regression adjusting for comorbidities. The proportion of SBO cases treated by LLOA increased nationwide by 1.6 percent per year (R20.87), from 17.2 % in 2006 to 28.7 % in 2013. Patients undergoing OLOA had longer operations (66 vs 60 min, P < 0.001), longer hospital stay (8.9 vs 4.2 days, P < 0.001), and higher post-surgical complication rates (adjusted odds ratio 2.73 95 % CI 2.36-3.15, P < 0.001) when compared to LLOA. Despite the lack of prospective randomized trials comparing LLOA to OLOA, we found progressive nationwide adoption of LLOA for SBO treatment. Our large retrospective analysis demonstrated clinical benefit and reduced resource utilization for LLOA.
authors: Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06510, USA. Kevin.Pei@yale.edu.|Yale School of Medicine, New Haven, CT, USA. Kevin.Pei@yale.edu.
authors: Kevin Y
authors: KY
authors: Pei
authors: Yale School of Medicine, New Haven, CT, USA.|Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: David
authors: D
authors: Asuzu
authors: Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06510, USA.|Yale School of Medicine, New Haven, CT, USA.
authors: Kimberly A
authors: KA
authors: Davis
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D059039:Standard of Care; D000267:Tissue Adhesions / Q000601:surgery*
keywords: Intestinal obstruction; Laparoscopy; Quality improvement; Tissue adhesions